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Aortic Valve Replacement with Toronto SPV Bioprosthesis: Excellent Patients Survival But Poor Valve Survival
T. E. David, C. M. Feindel, S. Armstrong, J. Bos, J. Ivanov. Toronto General Hospital, Toronto, ON, Canada,
BACKGROUND: To examine the long-term results of aortic valve replacement (AVR) with Toronto SPV bioprosthesis (T-SPV).
METHODS: A retrospective analysis of 357 prospectively followed patients whom had AVR with T-SPV revealed a mean age of 65±11 years and male gender in 68%. Aortic stenosis was present in 79% of the patients; senile calcification of a tricuspid aortic valve in 46%, bicuspid aortic valve disease in 35%, and coronary artery disease in 38%. The mean follow-up was 7.66±3.25 years and was 100% complete. All patients had multiple echocardiographic studies.
RESULTS: There were 2 operative and 79 late deaths (13 valve-related and 25 cardiac-related). All patients had aortic valve areas >0.85cm²/m². The 12 year survival was similar to that of the general population matched for age and sex. Fifty patients required repeat AVR, 45 for aortic insufficiency, mostly due to valve failure. Forty-five patients had echocardiographic evidence of valve failure, 38 confirmed at surgery. The most common mode of failure was aortic cusp tear with calcification. Kaplan-Meier estimates of survival and freedom from morbid events are shown in the following table.
| Time/Event | 1-year | 5-year | 8-year | 10-year | 12-year | | Survival | 97±1% | 91±1% | 82±2% | 75±3% | 63±4% | | Tromboembolism | 98±1% | 93±1% | 91±2% | 88±2% | 83±3% | | Endocarditis | 99% | 99% | 98±1% | 96±1% | 96±1% | | Aortic insufficiency 3+ & 4+ | 99% | 99% | 89±2% | 72±4% | 48±6% | | Structural valve degeneration | 100% | 100% | 95±1% | 86±3% | 69±5% | | Reoperation | 99% | 99% | 94±2% | 85±3% | 69±5% |
The freedom from valve failure at 12 years was 52±8% in patients <65 years of age and 85±4% in patients >65 years of age (p=0.002). At the most recent follow-up contact, 226 patients (63%) were alive with the T-SPV in place, and 69% were in class I, 24% in class II and 7% in class III.
CONCLUSIONS: AVR with T-SPV confers excellent patients survival but disappointedly high valve failure and reoperation rates.
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