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oa Cardiovascular Journal of Africa - Toronto stentless aortic valve replacement in elderly patients

Volume 7, Issue 2
  • ISSN : 1995-1892

 

Abstract

From July 1992 to October 1994, we inserted new Toronto SPV stentless aortic heterografts (SJM Med. Inc., St Paul, Minneapolis, USA) in 40 of a series of 50 consecutive patients older than 70 years. The mean age was 75.7 years (range 70 - 86 years). All, except 4 patients, were pre-operatively in NYHA functional class III or higher. The aortic clamp time was significantly higher in the stentless group (75 v. 53 minutes, P < 0.001). The average 25.5 mm size of the implanted valves stands in stark contrast to the low body surface area (1.69 m2 ) of this patient group. The surgeon's (in)experience was the major reason for the drawbacks (5/50) associated with a stentless procedure. The follow-up period ranged from 2 to 27 months and was complete in 100% of cases. We encountered 1 hospital death and no late deaths (97.5% actuarial survival). The mean NYHA class at follow-up was 1.5, and without exception patients were in class I or II. We noted one transient ischaemic attack immediately postoperatively and another later incident in a patient with a previous severe vascular history. With a low-intensity anticoagulation regimen for the first 3 months, there were two incidents of haemorrhaging necessitating premature anticoagula- tion withdrawal. Echocardiographic transthoracic valvular gradients compared favourably with the reported gradients of other biological valves, especially the smaller ones and significantly better haemodynamics were noted in most cases 6 months after implantation. Comparison of data with stented valves implanted during the same period indicates that the average size of the stentless valves was significantly higher (22.3 v. 25.5 mm, P < 0.001) in an equivalent population.

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/content/cardio1/7/2/AJA10159657_536
1996-04-01
2016-12-11

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