Key result
Stentless aortic valve replacement in patients aged 60 years and younger demonstrated an overall actuarial survival of 73.0% at 10 years and 55.8% at 15 years.
Cohort (n=188)
No
In patients aged 60 and younger, stentless aortic valve replacement provides reliable long-term survival and freedom from reoperation, particularly for larger prosthesis sizes.
Offers long-term benchmarks for stentless AVR in patients ≤60 years; leaves open randomized comparisons to stented or mechanical valves.
BACKGROUND: Stentless aortic valve replacement (SAVR) became a common surgical procedure to treat aortic valve disease, as it offers larger orifice area and improved hemodynamics. The aim of our single-centre retrospective study was to assess long term results of first generation stentless aortic valves in young patients, where mechanical prostheses are considered first line therapy. METHODS: From 1993 to 2001, 188 (149 male and 39 female) patients (≤60 years) underwent SAVR. Indications were in 63.3% stenosis or mixed lesions and in 36.7% isolated regurgitation. Mean age of patients at surgery was 53.1 ± 7.1 years. Associated procedures were performed in 60 patients (31.9%). Follow-up data were acquired through telephone interviews. Follow-up was 90.4% complete at a mean of 8.8 ± 4.7 years. Total follow-up was 1657.6 patient-years with a maximum of 17 years. RESULTS: Overall hospital mortality was 3.2% (2.5% for isolated SAVR). Overall actuarial survival-rate at 10/15 years and freedom from reoperation at 10/14 years were 73.0% ± 3.5%/ 55.8% ± 5.4% and 81.0% ± 3.4%/ 58.0% ± 7.5%, respectively. For isolated SAVR, actuarial survival at 10/15 years and freedom from reoperation at 10/14 years were 70.1% ± 4.4%/ 64.1% ± 4.8% and 83.1% ± 4.0%/ 52.9% ± 9.0%, respectively. Reoperation was performed in 42 patients (22.3%) due to structural valve deterioration and endocarditis. Age (≤50 years) and associated procedures did not significantly lower survival and freedom from reoperation, however, small prosthesis sizes (≤25 mm) did. CONCLUSION: In patients aged 60 and younger, SAVR provides reliable long-term results especially for larger aortic valves.
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Christ et al. (2013) conducted a cohort in Aortic valve disease (n=188). Stentless aortic valve replacement was evaluated on Overall actuarial survival at 10 years. Stentless aortic valve replacement in patients aged 60 years and younger demonstrated an overall actuarial survival of 73.0% at 10 years and 55.8% at 15 years.