BACKGROUND: The ideal biological valve(BV) for the 45-65yo remains controversial. Objective: To compare the results of BV for AVR in the 45-65yo, we reviewed our experience (1992-2002).
METHODS: All data were collected prospectively; 292pts between 45-65yo with aortic valve disease without coronary disease had a BV implanted : Freestyle valve(F) in 126pts, homograft(H) in 49pts, a stented Mosaic or Perimount(M-P) in 48pts and a Ross procedure(R) in 69pts.
RESULTS: Perioperative mortality was comparable (F:0.8%, H:4.1%, M-P:0%, R:1.5%; p=0.3). Echocardiography performance was significantly enhanced with R and H compared to F or M-P : indexed effective orifice area(cm2/m2): F:0.9+/-0.3; H:1.2+/-0.3, M-P:0.9+/-0.2, R:1.4+/-0.4, p<0.0001; mean gradient(mmHg): F:13.0+/-6.7, H:7.5+/-4.0; M-P:14.6+/-5.5, R:4.5+/-3.1, p<0.0001. Mean follow-up was 4.6+/-2.7yrs. For all yearly follow-up, freedom from NYHAIII-IV was comparable and over 95%. At 7 years, overall survival was significantly lower with the F (H:94 :%, R:96%, M-P:87%, F:71%; p=0.05) although cardiac survival was comparable (H:96%, R:96%, M-P:98%, F:88%; p=0.8). Freedom from reoperation: R: 98%, H:88%, F:87%, M-P:87%; p=0.2; and from valve dysfunction: R:93%, H:89%, F:93%, M-P:93%; p=ns were comparable. Freedom from bleeding events, valve related neurologic event or endocarditis were comparable and over 95%.
CONCLUSIONS: Type of BV for AVR in the 45-65yo does not impact mid-term survival or valve related morbidity. Valve performance is enhanced with a H or R without resulting in functional class improvement. New generation stented BV show comparable mid-term outcome to stentless BV. Longer follow-up is required to determine if stentless BV will be superior.

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