# Long-term outcomes of the largest (29) Epic Supra aortic valve bioprosthesis: comparing recommended with upsizing implantation

## TL;DR

This study examines the long-term outcomes of using the largest Epic Supra aortic valve in patients, comparing recommended and upsizing implantation methods.

## Contribution

The study presents the largest global experience with the Epic Supra size 29 valve and evaluates its use in smaller annuli.

## Key findings

- The 29 size prosthesis showed exemplary clinical and haemodynamic performance.
- Implantation in smaller annuli was safe and may improve future valve-in-valve options.
- Long-term follow-up showed low reoperation rates, mainly due to infective endocarditis.

## Abstract

To investigate outcomes of aortic valve replacement with the largest available Epic Supra bioprosthesis (size 29).

We reviewed all patients who received an Epic Supra bioprosthesis between 2011 and 2023 and selected all 29 size prostheses that were implanted either into patients with an aortic annulus of at least 29 mm (sizing as recommended by the manufacturer) or into patients with smaller annuli (upsizing). Short- and long-term results were assessed. Propensity score matching was employed to improve comparability between groups. Kaplan–Meier and log-rank tests were performed to compare survival.

Epic Supra bioprostheses were implanted into 1845 patients between 2011 and 2023. Mean age was 69.7 (11.2) years and 79.2% were male. Size 29 was implanted in 360 patients (mean age 68 (8.9) years), and 97.2% were male. EuroScore II was 5.1 (1.3; 6.6). One quarter of cases were performed via parasternal minithoracotomy. Mortality at 30 days was 2.8%, with no significant differences. Need for re-exploration was 3.3% and permanent pacemaker implantation was 4.7% (no statistically significant differences). Longest follow-up was 10 years with a mean of 50 (41) months. Mean prosthetic pressure gradients were 11.3 (16.7) mmHg and aortic valve reoperations/interventions were required in 5 patients (1.4%), all due to infective endocarditis.

This is the largest experience of Epic Supra 29 implantation worldwide. Our results illustrate exemplary clinical and haemodynamic performance. In addition, the 29 size prosthesis can safely be implanted into patients with smaller than 29 mm annulus, which may improve future valve-in-valve options.

Aortic valve bioprostheses are provided in a wide range of sizes (classically labelled size 19 to 29).