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INTERMEDIATE TERM EVALUATION OF HEMODYNAMIC BEHAVIOUR AND PATIENT PROSTHESIS MISMATCH AT REST AND UNDER STRESS AFTER AORTIC VALVE REPLACEMENT WITH SORIN FREEDOM PERICARDIAL STENTLESS PROSTHESIS.
GUGLIELMO STEFANELLI, FABRIZIO PIRRO, ALINA OLARU, CLORINDA LABIA, MASSIMO LONGO, MARCO MELI.
Hesperia Hospital, modena, Italy.

OBJECTIVE: To evaluate the hemodynamic behaviour of Sorin Freedom stentless valve under stress conditions and to encourage the choice of an aortic prosthesis in relation to a better quality of life of the patient.
METHODS: Between March 2003 and April 2010, 184 patients who received a Pericarbon Sorin Freedom (PSF) stentless aortic prosthesis at our Unit underwent an Echocardiographic evaluation at rest and under stress conditions at a mean follow-up time of 6,8 years.The mean age of the patients was 69,7±10,9.Mean Log Euroscore was 7,73 ± 7,03.Concomitant procedures were carried out in 41,3 % of cases.The stress protocol consisted of a max exercise of 100 w for 6 minutes at cycle-ergometer.Assessment of Max/Mean aortic gradient,effective orifice area,effective orifice area index were obtained by Echo examination ,along with assessment of patient/prosthesis mismatch,NYHA functional class,percentage of reduction in ventricular mass.
RESULTS: A low increase of mean (from 7,8±3,3mmHg to 11,6±4.0mmHg) and peak (from 14,9±5,2mmHg to 21,6±6,5mmHg) gradients even under maximum exercise was observed Interestingly there was an increase in the effective orifice areas related to a possible dynamical valve adaption to changes of patient’s hemodynamics.The patient/prosthesis mismatch was virtually absent,.The clinical conditions were excellent for the majority of the patients .
CONCLUSIONS: The hemodynamic evaluation of SPF at rest and under stress showed excellent performances.A good capability of valve adaption to changes in cardiac output has been observed.Therefore the SPF can be considered a good option within the aortic valve substitutes in the younger, active population and an excellent prosthesis in cases of bacterial endocarditis.


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