Review
Aortic Valve Replacement With the Stentless Freedom SOLO Bioprosthesis: A Systematic Review

https://doi.org/10.1016/j.athoracsur.2015.06.048Get rights and content

This systematic review examined the clinical and hemodynamic performance of the stentless Freedom SOLO (Sorin Group, Milan, Italy) aortic bioprosthesis. The occurrence of postoperative thrombocytopenia was also analyzed. The Freedom SOLO is safe to use in everyday practice, with short cross-clamp times, and postoperative pacemaker implantation is notably lower. Valvular gradients are low and remain stable during short-term follow-up. Thrombocytopenia is more severe than in other aortic prostheses; however, this is without clinical consequences. Within a few years, the 15-year follow-up of this bioprosthesis will be known, which will be key to evaluating its long-term durability.

Section snippets

Material and Methods

A literature search of MEDLINE, EMBASE, and The Cochrane library (Fig 2) was done using the search terms “freedom SOLO” or “stentless SOLO.” The articles were selected independently by 2 reviewers (L.W. and W.L.) and are presented in Figure 2. After duplicates were removed, 97 titles were screened. Inclusion criteria for the title and abstract screening were “everything on the Freedom SOLO bioprosthesis.” After title screening, 20 titles were excluded (98% agreement). Seventy-seven abstracts

Clinical Outcomes

Table 1 and Table 2 show the clinical outcomes and follow-up of 2,185 patients with a Freedom SOLO. In 22 studies, the mean age was 74 years, concomitant procedures were performed in 39% of the patients, and the mean cross-clamp time for isolated AVR with the Freedom SOLO was 66 minutes. Seventy-seven patients (10%) underwent an operation for isolated aortic valve insufficiency (AoI). Mean European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 8 and the mean logistic EuroSCORE

Comment

This systematic review shows that AVR with the Freedom SOLO is safe and feasible, with good prosthesis performance after a mean follow-up of 22 months (maximum, 83 months). Operative mortality of 3.5% and stroke rate of 1.1% in 2,185 patients with 39% concomitant procedures is comparable with other studies. Data from The Society of Thoracic Surgeons National Database shows an observed mortality of 3.0% and stroke in 1.5% in 141,905 isolated AVRs [3].

The Freedom SOLO shows excellent outcomes

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