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

• Published in: The Journal of Thoracic and Cardiovascular Surgery
• Main Authors: Dagnegård, Hanna H., Bekke, Kirstine, Kolseth, Solveig M., Glaser, Natalie, Wallén, Christoffer, El-Hamamsy, Ismail, Víðisson, Kristján O., Lie, Asbjørn S., Valentin, Jan B., Sartipy, Ulrik, Haaverstad, Rune, Vanky, Farkas, Lefebvre, Laurence, Guðbjartsson, Tómas, Johnsen, Søren P., Søndergaard, Lars, Thyregod, Gustav H., Lund, Jens T., Ihlemann, Nikolaj, Smerup, Morten H.
• Other Authors: Faculty of Medicine, Cardio-Vascular Center, Landspitali - The National University Hospital of Iceland
• Format: Article in Journal/Newspaper
• Language: English
• Published: 2021
• Subjects: Hjartasjúkdómar; Hjartaþelsbólga; Hjarta- og lungnaskurðlæknisfræði; aortic root replacement; endocarditis; full root bioprosthesis; reinterventions; survival; type A dissections; Surgery; Pulmonary and Respiratory Medicine; Cardiology and Cardiovascular Medicine; Hjarta; North Atlantic
• Online Access: https://hdl.handle.net/20.500.11815/2888; https://doi.org/10.1016/j.jtcvs.2021.07.011

Publisher Copyright: © 2021 The Authors 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. Peer reviewed