Long-term outcomes of the largest (29) Epic Supra aortic valve bioprosthesis: comparing recommended with upsizing implantation

OBJECTIVES: To investigate outcomes of aortic valve replacement with the largest available Epic Supra bioprosthesis (size 29). METHODS: We reviewed all patients who received an Epic Supra bioprosthesis between 2011 and 2023 and selected all 29 size prostheses that were implanted either into patients with an aortic annulus of at least 29 mm (sizing as recommended by the manufacturer) or into patients with smaller annuli (upsizing). Short- and long-term results were assessed. Propensity score matching was employed to improve comparability between groups. Kaplan-Meier and log-rank tests were performed to compare survival. RESULTS: Epic Supra bioprostheses were implanted into 1845 patients between 2011 and 2023. Mean age was 69.7 (11.2) years and 79.2% were male. Size 29 was implanted in 360 patients (mean age 68 (8.9) years), and 97.2% were male. EuroScore II was 5.1 (1.3; 6.6). One quarter of cases were performed via parasternal minithoracotomy. Mortality at 30 days was 2.8%, with no significant differences. Need for re-exploration was 3.3% and permanent pacemaker implantation was 4.7% (no statistically significant differences). Longest follow-up was 10 years with a mean of 50 (41) months. Mean prosthetic pressure gradients were 11.3 (16.7) mmHg and aortic valve reoperations/interventions were required in 5 patients (1.4%), all due to infective endocarditis. CONCLUSIONS: This is the largest experience of Epic Supra 29 implantation worldwide. Our results illustrate exemplary clinical and haemodynamic performance. In addition, the 29 size prosthesis can safely be implanted into patients with smaller than 29 mm annulus, which may improve future valve-in-valve options.