Dai Une    Department   Kawasaki Medical School  Kawasaki Medical School, Department of Cardiovascular Surgery,    Position   Professor
Article types	原著
Language	English
Peer review	Peer reviewed
Title	Long-term clinical outcomes of the Toronto stentless porcine valve: 15-year results from dual centers.
Journal	Formal name：Journal of cardiac surgery Abbreviation：J Card Surg ISSN code：15408191/08860440
Domestic / Foregin	Foregin
Volume, Issue, Page	35(9),pp.2279-2285
Author and coauthor	Dai Une, Reena Karkhanis, Tirone E David, Daisuke Machida, Munetaka Masuda, Bernard S Goldman
Authorship	Lead author
Publication date	2020/09
Summary	BACKGROUND AND AIM OF THE STUDY:The purpose of this study is to examine the long-term durability of the Toronto stentless porcine valve (SPV) in the aortic position (St Jude Medical, Minneapolis, MN).METHODS:We assessed the long-term clinical outcomes of 515 patients with aortic valve replacement (AVR) with the Toronto SPV from 1987 to 2001 at two centers, excluding early (<30 days) death. Median follow-up was 11.5 years (maximum 19.0 years).RESULTS:Average age was 64.2 ± 10.8 years, and females were 34% (173/515). The incidence of prosthesis-patient mismatch was low, 10.9%. Overall survival was 90.7 ± 1.3%, 75.4 ± 2.0%, and 56.8 ± 3.2% at 5, 10, and 15 years, respectively after surgery. Over the follow-up duration, 116 patients (23%) underwent repeated AVR: 90 for structural valve deterioration (SVD), 12 for endocarditis, 10 nonstructural valve dysfunction (10 aortic regurgitation due to aorta dilatation), and four for other reasons. The cumulative incidence of repeated AVR with death as a competing risk was 1.4% (95% confidence interval [CI], 0.6-2.7), 11.1% (95% CI, 8.4-14.2), and 34.4% (95% CI, 28.8-40.2) at 5, 10, and 15 years, respectively. Reoperative mortality was 5.2% (6/116). In SVD, the regurgitation type was dominant (82%).CONCLUSIONS:The Toronto SPV is associated with excellent survival and durability during the first decade of follow-up. However, regurgitation type of SVD increases from 10 years after operation with acceptable reoperative mortality. These findings may assist with prosthesis selection and reintervention strategy for failing stentless bioprosthesis.
DOI	10.1111/jocs.14837
PMID	32720369