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Background: Worldwide there's increased use of bio-prosthetic valves in the aortic position. Part of this increase has been patient-driven for quality of life reasons. More recently bio-prosthetic valves are chosen by progressively younger patients with the strategy to perform a valve-in-valve TAVI if they should wear out. Therefore we reviewed our experience with patients whose first two aortic valve replacements (AVR) were with bio-prosthetic valves.

Methods: Patients receiving consecutive bio-prosthetic AVR performed by the Green Lane Cardiothoracic Surgical Unit were identified from a departmental database. Data retrieved from prospective databases, electronic and archived clinical records. Outcomes of interest were overall survival and freedom from third or more AVR.

Results: 267 patients met inclusion criteria with a mean follow up of 22.3 years. Concurrent procedures (CABG etc.) were performed in 65.2% of …