Durability of a bovine pericardial aortic bioprosthesis based on Valve Academic Research Consortium-3 echocardiographic criteria

Five-Year Results of Aortic Valve Replacement With a Novel Bioprosthesis: Real-World Data From a Large Multicenter Registry

BACKGROUND

The clinical performance and safety of a glutaraldehyde-free bioprosthetic valve using a novel tissue treatment in a large real-world patient population have not previously been reported.

METHODS

This is a prospective, multicenter, real-world registry of all patients undergoing surgical aortic valve replacement with a novel bioprosthesis at 7 European cardiac surgery centers. The primary end point was the 5-year freedom from structural valve deterioration per Valve Academic Research Consortium 3 criteria. Secondary end points included hemodynamic performance of the bioprosthesis and freedom from all-cause and cardiovascular mortality, prosthetic endocarditis, stroke, and reintervention at 5 years.

RESULTS

A total of 498 patients were included in the analysis; the mean age was 60.1 years, with a mean EuroSCORE II of 3.9% and 27.9% being female. The median follow-up was 4.8 years. Five-year freedom from structural valve deterioration stages 1, 2, and 3 was 95.7%, 98.6%, and 99.3%, respectively. The estimated 5-year overall survival was 93.2%; freedom from cardiovascular mortality was 97.2%. Event-free probabilities at 5 years for endocarditis, stroke, and reintervention were 98.6%, 98.1%, and 98.2%, respectively. Moderate-severe paravalvular leakage was infrequent (97.3% event-free probability at 5 years), and mean aortic valve pressure gradient was stable compared with discharge (median, 11.0 mm Hg at discharge vs 12.0 mm Hg at 5 years).

CONCLUSIONS

These real-world clinical data of a novel aortic bioprosthesis demonstrated good 5-year results for both durability and safety outcomes as well as stable hemodynamic valve performance.

Late clinical and echocardiographic results with the Magna Ease© pericardial aortic bioprosthesis

OBJECTIVES

The population of candidates to surgical aortic valve replacement (SAVR) is evolving. The Perimount Magna Ease© bioprosthesis has been introduced relatively recently in the practice. We aimed at evaluating its long-term results.

METHODS

This article describes a single-centre cohort of 1016 consecutive SAVRs with the Magna Ease© valve (2008-2014), consisting of an all-comers population. We performed a prospective collection of in-hospital data, systematic clinical and echocardiographic follow-up. Valve-related events were as follows: structural valve deterioration (SVD; according to modified definition criteria), nonstructural valve dysfunction, patient-prosthesis mismatch (PPM).

RESULTS

Age at SAVR was 73.4 ± 9.5 years; calcified aortic stenosis was the indication to surgery in 59.6%. A total of 974 patients entered the follow-up; 564 were alive at the last follow-up (median duration: 9.8 years) (up to 13.4 years). New York Heart Association class was I or II in 92.1%. Overall survival at 10 years was 56.8 ± 1.8%. Freedom from SVD at 10 was 96.5 ± 0.8% (Kaplan-Meier) and 97.4 ± 0.6% (competing risks) (28 SVD events after 6.9 ± 3.3 years). There were 15 reinterventions for SVD (redo-SAVR and Transcatheter Aortic Valve Implantation (TAVI)); 10-year freedom from reintervention was 97.8 ± 0.6%. Moderate and severe PPM occurred in 26.8% and 5.4%, respectively, without association with late mortality (P = 0.12 for moderate and P = 0.70 for severe PPM). Freedom from valve-related mortality was 97.8 ± 0.5% at 10 years.

CONCLUSIONS

In this follow-up of the Magna Ease bioprosthesis for SAVR, data indicate good late outcomes (30-day outcomes are excluded). Continued follow-up is required to further support its use in patients with life expectancy >10-12 years.