Survival after aortic root replacement with a stentless xenograft is determined by patient characteristics

J Thorac Cardiovasc Surg. 2022 Dec;164(6):1712-1724.e10. doi: 10.1016/j.jtcvs.2021.07.011. Epub 2021 Jul 17.

Abstract

Objectives: Our objective was to examine intermediate-term survival and reinterventions in unselected patients, stratified according to indication, who received a Freestyle (Medtronic Inc, Minneapolis, Minn) bioprosthesis as a full aortic root replacement.

Methods: Data from medical records were retrospectively collected for patients who had aortic root replacement using Freestyle bioprostheses between 1999 and 2018 at 6 North-Atlantic centers. Survival status was extracted from national registries and results stratified according to indication for surgery.

Results: We included 1030 implantations in 1008 patients with elective indications for surgery: aneurysm (39.8%), small root (8.3%), and other (13.8%), and urgent/emergent indications: endocarditis (26.7%) and Stanford type A aortic dissection (11.4%). Across indications, 46.3% were nonelective cases and 34.0% were reoperations. Median age was 66.0 (interquartile range, 58.0-71.8) years and median follow-up was 5.0 (interquartile range, 2.6-7.9) years. Thirty-day mortality varied from 2.9% to 27.4% depending on indication. Intermediate survival for 90-day survivors with elective indications were not different from the general population standardized for age and sex (P = .95, .83, and .16 for aneurysms, small roots, and other, respectively). In contrast, patients with endocarditis and type A dissection had excess mortality (P < .001). Freedom from valve reinterventions was 95.0% and 94.4% at 5 and 8 years, respectively. In all, 52 patients (5.2%) underwent reinterventions, most because of endocarditis.

Conclusions: At intermediate term follow-up this retrospective study provides further support for the use of the Freestyle bioprosthesis in the real-world setting of diverse, complex, and often high-risk aortic root replacement and suggests that outcome is determined by patient and disease, rather than by prosthesis, characteristics.

Keywords: aortic root replacement; endocarditis; full root bioprosthesis; reinterventions; survival; type A dissections.

MeSH terms

  • Aged
  • Aortic Valve / diagnostic imaging
  • Aortic Valve / surgery
  • Bioprosthesis*
  • Endocarditis* / surgery
  • Follow-Up Studies
  • Heart Valve Prosthesis Implantation* / methods
  • Heart Valve Prosthesis*
  • Heterografts
  • Humans
  • Prosthesis Design
  • Retrospective Studies
  • Treatment Outcome