Risk Factors for Structural Valve Deterioration of the Aortic Sutureless Prosthesis in a 10-Year Follow-up Study

Background: Surgical aortic valve replacement (AVR) with a sutureless prosthesis showed good early- and midterm results. In this study we aimed to assess the risk factors for structural valve deterioration (SVD) in a 10-year follow-up.

Method: We retrospectively analyzed patients who underwent successfully AVR with a Perceval or Perceval Plus (LivaNova, Saluggia, Italy) prosthesis in our center between 2010 and September 2019. Patients with a prior AVR, with infective endocarditis or combined mitral valve replacement, were excluded. Baseline, intra- and postoperative data were prospectively collected. A clinical follow-up including a transthoracic echocardiography was performed up to May 2021. SVD was defined according to the European guidelines. Cox-regression analysis was performed to assess risk factors for SVD.

Results: A total of 547 patients were eligible for the analysis. Mean age was 76.4 ± 5.2 years (range: 58–91), 51% of patients were female, and logistic EuroSCORE and EuroSCORE II were 13% ± 10 and 3.4% ± 2.6, respectively. No operative mortality was recorded. The in-hospital and 30-day mortality rates were 2.9 and 3.3%, respectively. None of these deadly events was correlated to the implanted valve. The mean follow-up was 3.8 ± 2.4 years (median: 3.8, range: 0–10.6). Actuarial survival was 92.3% at 2 years, 85.9% at 4 years, 80.4% at 6 years, 77.5% at 8 years and 76.8% at 10 years. SVD was observed in 22 patients (including 1 case of moderate SVD) for an incidence of 1.5% patient/year. The implanted sizes in these patients were as follows: “M” (n = 10), “L” (n = 11), and “XL” (n = 1). Five patients showed a mean gradient >20 mm Hg already at hospital discharge. 19 patients underwent reintervention in aortic position. Mean freedom from SVD was 9 years (±0.2). The multivariate Cox-analysis showed age (HF = 0.87, 95% CI: 0.78–0.96, p = 0.004) and diabetes mellitus (HF = 5.99, 95% CI: 2.2–16.1, p < 0.01) correlated with the development of SVD.

Conclusion: In this 10-year-follow-up, the sutureless prosthesis showed to be a reliable choice for a tissue valve in the aortic position in patients with a severe stenosis. Young patients and those who are affected by diabetes mellitus should be closely monitored.

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Artikel online veröffentlicht:
03. Februar 2022