Long-term outcomes of the largest (29) Epic Supra aortic valve bioprosthesis: comparing recommended with upsizing implantation

OBJECTIVES

To investigate outcomes of aortic valve replacement with the largest available Epic Supra bioprosthesis (size 29).

METHODS

We reviewed all patients who received an Epic Supra bioprosthesis between 2011 and 2023 and selected all 29 size prostheses that were implanted either into patients with an aortic annulus of at least 29 mm (sizing as recommended by the manufacturer) or into patients with smaller annuli (upsizing). Short- and long-term results were assessed. Propensity score matching was employed to improve comparability between groups. Kaplan-Meier and log-rank tests were performed to compare survival.

RESULTS

Epic Supra bioprostheses were implanted into 1845 patients between 2011 and 2023. Mean age was 69.7 (11.2) years and 79.2% were male. Size 29 was implanted in 360 patients (mean age 68 (8.9) years), and 97.2% were male. EuroScore II was 5.1 (1.3; 6.6). One quarter of cases were performed via parasternal minithoracotomy. Mortality at 30 days was 2.8%, with no significant differences. Need for re-exploration was 3.3% and permanent pacemaker implantation was 4.7% (no statistically significant differences). Longest follow-up was 10 years with a mean of 50 (41) months. Mean prosthetic pressure gradients were 11.3 (16.7) mmHg and aortic valve reoperations/interventions were required in 5 patients (1.4%), all due to infective endocarditis.

CONCLUSIONS

This is the largest experience of Epic Supra 29 implantation worldwide. Our results illustrate exemplary clinical and haemodynamic performance. In addition, the 29 size prosthesis can safely be implanted into patients with smaller than 29 mm annulus, which may improve future valve-in-valve options.

Cardiac surgery 2017 reviewed

For the year 2017, more than 21,000 published references can be found in PubMed when entering the search term "cardiac surgery". This review focusses on conventional cardiac surgery, considering the new interventional techniques only if they were directly compared to classic techniques but also entails aspects of perioperative intensive care management. The publications last year provided a plethora of new and interesting information that helped to quantify classic surgical treatment effects and provided new guidelines for the management of structural heart disease, which made comparisons to interventional techniques easier. The field of coronary bypass surgery was primarily filled with confirmatory evidence for the beneficial role of coronary artery bypass grafting for complex coronary disease and equal outcomes for percutaneous coronary intervention for less complex disease including main stem lesions. For aortic valve treatment, the new guidelines provide an equal recommendation for surgical and transcatheter aortic valve replacement for high and intermediate risk giving specific check lists to individualize decision-making by the heart team. For low-risk aortic stenosis, surgical valve replacement remains the primary indication. For the mitral valve, the importance of surgical experience of the individual surgeon on short- and long-term outcome was presented and the prognostic impact of mitral repair for primary mitral regurgitation was emphasized. In addition, there were many relevant and interesting other contributions from the purely operative arena in the fields of tricuspid disease as well as terminal heart failure (i.e., transplantation and ventricular assist devices). While this article attempts to summarize the most pertinent publications, it does not have the expectation of being complete and cannot be free of individual interpretation. As in recent years, it provides a condensed summary that is intended to give the reader "solid ground" for up-to-date decision-making in cardiac surgery.