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Fabio Barili
Luca Dainese
Massimo Porqueddu
Andrea Sala
Paolo Biglioli
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Ann Thorac Surg 2005;80:495-501
© 2005 The Society of Thoracic Surgeons

Original article: Cardiovascular

Long-Term Results After Aortic Valve Replacement With the Bravo 400 Stentless Xenograft

Gianluca Polvani, MD a , Fabio Barili, MD a , * , Luca Dainese, MD a , Manuela Muratori, MD a , Massimo Porqueddu, MD a , Andrea Sala, MD b , Paolo Biglioli, MD a

a Department of Cardiac Surgery and Cardiology, University of Milan, Centro Cardiologico Monzino IRCCS, Milan, Italy
b Department of Cardiac Surgery, University of Insubria, Ospedale di Circolo "Fondazione Macchi," Varese, Italy

Accepted for publication March 3, 2005.

* Address reprint requests to Dr Barili, Department of Cardiac Surgery, University of Milan, Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138 Milan, Italy (Email: fabarili{at}libero.it).

BACKGROUND: This study was undertaken to evaluate the long-term clinical and echocardiographic outcome after aortic valve replacement with the Bravo Cardiovascular Model 400 stentless xenograft.

METHODS: Between February 1992 and January 1994, 67 patients underwent aortic valve replacement with the Bravo 400 bioprosthesis. The valvular pathology was aortic stenosis in 36 patients (53.7%), aortic insufficiency in 17 patients (25.4%), and mixed lesion in 14 patients (20.9%). Mean follow-up time was 9.8 ± 2.73 years and median follow-up time was 11 years. Cumulative follow-up time was 659 patients-years and was 94% complete.

RESULTS: No early deaths were observed. Overall survival estimates at 11 years were 74.71% ± 5.47%. The actuarial freedom from valve-related death at 11 years was 91.04% ± 3.84%; from cardiac-related death at 11 years it was 87.95% ± 4.29%; and from noncardiac death at 11 years it was 85.14% ± 4.58%. Eleven-year Kaplan-Meier survival of patients younger than 65 years was 90.91% ± 6.13% versus 66.08% ± 7.38% for older patients (p = 0.0307, log-rank test). The actuarial freedom from all valve-related morbidity and mortality at 11 years was 80.3% ± 5.4%. The mean transvalvular gradient decreased significantly after aortic valve replacement with a corresponding increase in effective orifice area. Left ventricular mass index at 10-year follow-up was 68.5% of the preoperative value.

CONCLUSIONS: The Bravo Cardiovascular Model 400 stentless xenograft has provided good clinical and hemodynamic results up until 11 years of follow-up.




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