Echocardiographic assessment of aortic valve replacement with stentless porcine xenografts

Abstract Stentless porcine xenografts (SPXs) implanted in the aortic position have potential hemodynamic advantages over traditional valve prostheses because of the lack of a rigid stent. Twenty-four patients (mean age 59 years) who underwent aortic valve replacement with SPXs were studied by echocardiography early after and 26 ± 10 months (range 8 to 40) after operation. Peak and mean gradients, as well as aortic valve area, did not change significant from baseline (16.3 ± 8 and 9.8 ± 5.6 mm Hg, and 1.78 ± 0.63 cm 2 , respectively) to follow-up study (12.5 ± 5 and 7.7 ± 3 mm Hg, and 1.8 ± 0.65 cm 2 , respectively). At baseline, color flow Doppler imaging showed aortic valve regurgitation where the leaflets coapted centrally in 17 of 24 patients (trivial, n=14; mild, n=3). Besides the central leak, paravalvular regurgitation was seen in 4 patients (trivial, n=3; mild, n=1). At follow-up, 18 of 24 patients had aortic valve regurgitation (trivial, n=11; mild, n=6; and moderate, n=1). New valvular regurgitation (graded as trivial, n=2; mild, n=2; and moderate, n=1) was detected in 5-patients, and new paravalvular regurgitation (graded as mild) developed in 1 patient. Two patients underwent repeat operation for valve-related complications: (1) rupture of a valve cusp with acute pulmonary edema, and (2) fibrotic stenosis of the left coronary ostium with unstable angina. In conclusion, this study demonstrates good hemodynamic performance of the SPX in the aortic position. The rupture of a valve cusp in 1 patient raises the question of the durability of SPXs. Long-term follow-up studies are mandatory to assess the longevity of these new prosthetic valves.