A European Multicenter Study of 616 Patients Receiving the Freedom Solo Stentless Bioprosthesis

Solo Smart stentless bioprosthesis for redo aortic valve replacement

BACKGROUND

In the redo aortic valve replacement (AVR), removal of the previously implanted damaged prosthesis may result in a native aortic annulus defect, making it difficult to reimplant a stented prosthesis. The Solo Smart valve, a relatively new stentless bioprosthesis, is designed for the supra-annular implantation into the wall of the sinus of Valsalva and may be a useful alternative to redo-AVR.

CASE REPORT

We report a successful case of redo-AVR using the Solo Smart valve.

CONCLUSION

The unique feature of the Solo Smart valve is the supra-annular implantation procedure in the sinus of Valsalva without annular stitches. This bioprosthesis can be a useful alternative for redo-AVR in patients with a defect of the native aortic annulus.

Solo Smart Stentless Bioprosthesis for Infective Valve Endocarditis with Aortic Annular Abscess

So far, there is still controversy regarding the optimal prosthetic valve for patients with active infective valve endocarditis with annular abscess. Here, we report the case of a 65-year-old woman who was diagnosed with infective endocarditis associated with extensive annular abscess. The patient underwent debridement of the abscess cavity followed by aortic valve replacement using a Solo Smart (SS) stentless bioprosthesis. Postoperative recovery was uneventful, with no signs of recurrent infection. Since the SS valve is designed for supra-annular and subcoronary implantation, it is considered to be an alternative to conventional prosthetic valves in patients with infective endocarditis with aortic annular abscess.

Hemodynamic and clinical performance of Solo stentless bioprosthetic aortic valves

OBJECTIVE

To report the hemodynamic profile and short- and medium-term outcomes of Freedom Solo and Solo Smart stentless aortic valves implanted at our center.

METHODS

Between 2009 and 2015, all patients undergoing aortic valve replacement using Solo stentless valves at our center were enrolled. Clinical and echocardiographic follow-up was carried out six months postoperatively. Survival and major events, including structural valve deterioration and non-structural valve dysfunction, endocarditis, reoperation and stroke, were assessed through medical records or telephone interview with the referring cardiologist up to November 2015 (mean and maximum follow-up 39±22 and 78 months, respectively).

RESULTS

Patients' (n=345) mean age was 72±8 years, 52% were female and median euroSCORE II was 2.7 (1.5-4.7). There was no intraoperative mortality and in-hospital mortality was 2.6%. Postoperatively, mean transvalvular gradient was 11.9±4.5 mmHg and effective orifice area was 1.9±0.5 cm². Patient-prosthesis mismatch occurred in 14% but was severe in only one patient. Cumulative survival at six years was 72%. Six patients were reoperated: three due to endocarditis, two for structural prosthesis deterioration and one because of periprosthetic fistula. Five patients suffered stroke, three had medically-treated endocarditis and one had structural valve deterioration but was not considered suitable for reoperation. None of the remainder had structural valve deterioration or non-structural valve dysfunction.

CONCLUSIONS

Solo stentless aortic valves are safe to implant, with promising clinical outcomes in short- and medium-term assessment. Moreover, they show an excellent hemodynamic performance: low transvalvular gradients, large effective orifice areas and low incidence of patient-prosthesis mismatch.