Six-year follow-up of the Toronto stentless porcine valve.

: Stentless valves in the aortic position have been shown to have superior hemodynamic performance to stented valves and have now been shown to increase survival. We report the medium-term results from a single center of 229 Toronto (SPV) aortic valve replacements between 1994 and 2000. The mean age of the patients was 72 years (range, 41-87 years). The mean Euroscores were 6.2 (+/-0.13) and Parsonnet scores of 16.8 (+/-0.5). Concomitant coronary artery bypass grafting was performed in 125 (55%) of patients, eight patients had additional mitral valve replacements and ten were redo procedures. Hospital mortality was 3.5%. The mean follow-up period was 45 (7-81) months. The actuarial survival was 92.4% (+/-1.4%) at one year and 76.2% (+/-3.5%) at five years. There were 37 late deaths (4.7% per patient years). There were 3 patients with prosthetic valve endocarditis (0.38% per patient years), two of whom died. Stroke occurred in 13 patients (1.6% per patient years), five of whom died. None of these events were known to be valve related. There was no incidence of structural valve dysfunction and no valves have been explanted. At follow-up, the mean transvalvular gradient was 4.2 mm Hg (range, 0.9-12.7 mm Hg). No aortic incompetence (AI) was seen in 88% of patients with trivial or mild AI in 11% of patients and moderate AI in one patient. This series shows acceptable early and medium-term results in an elderly population with a high incidence of coronary artery disease.