Hemodynamic features of the freestyle aortic bioprosthesis compared with stented bioprosthesis

• Published in: The Annals of thoracic surgery Vol. 66; no. 6; pp. S130 - S133
• Main Authors: Dumesnil, Jean G, LeBlanc, Marie-Hélène, Cartier, Paul C, Métras, Jacques, Desaulniers, Denis, Doyle, Daniel P, Lemieux, Michel D, Raymond, Gilles
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01-12-1998; Elsevier Science
• Subjects: Aged; Aged, 80 and over; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Insufficiency - etiology; Biological and medical sciences; Bioprosthesis - adverse effects; Blood Flow Velocity - physiology; Blood Pressure - physiology; Cardiac Output - physiology; Cardiology. Vascular system; Echocardiography, Doppler; Endocardial and cardiac valvular diseases; Female; Follow-Up Studies; Heart; Heart Valve Prosthesis - adverse effects; Hemodynamics - physiology; Humans; Incidence; Male; Medical sciences; Middle Aged; Prosthesis Design; Stroke Volume - physiology; Surface Properties; Ventricular Function, Left - physiology; Sonography; Doppler ultrasound study; Human; Echocardiography; Prosthesis; Cardiovascular disease; Exploration; Implantation; Replacement; Aortic valve disease; Stentless prosthese; Treatment; Cardiac valvular disease; Follow up study; Surgery; Bioprosthese; Hemodynamics; Aortic valve; Comparative study
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(98)01119-9

Background. The Freestyle prosthesis is a new stentless aortic bioprosthesis. Anticipated benefits are improved hemodynamics and increased longevity.
Methods. Doppler echocardiograms were performed early and at 3 to 6 months, 1 year, and 2 years after operation in 157 patients (69 men, 88 women, aged 48 to 85 years) with this prosthesis, and results were compared with hemodynamic data in patients with Intact and Mosaic stented bioprostheses.
Results. Distinctive features of the prosthesis compared with stented prostheses are (1) an increase in effective orifice area (+0.15 ± 0.26 cm
2;
p < 0.05) and a decrease in mean gradient (−3.5 ± 4.0 mm Hg;
p < 0.001) during the first 3 to 6 months postoperatively and stabilization thereafter; (2) a markedly lower mean gradient at 1 year after operation (average, 6 ± 4 mm Hg) than in stented prostheses (Intact, 22 ± 8 mm Hg; Mosaic, 12 ± 6 mm Hg); (3) in contrast to stented prostheses, in vivo effective orifice areas much lower (−0.91 ± 0.35 cm
2) than those calculated in vitro; (4) as in stented prostheses, the indexed effective orifice area (cm
2/m
2) is the best predictor (r = 0.77 at 1 year) of the mean gradient after operation; and (5) similar incidence of aortic regurgitation (trivial or mild, 34% versus 29% in Intact).
Conclusions. The hemodynamics of the Freestyle are very satisfactory and represent a marked improvement in comparison to stented prosthesis.