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

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


Title: Survival after aortic root replacement with a stentless xenograft is determined by patient characteristics
Author: 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
... 10 more authors Show all authors
Date: 2021
Language: English
Scope:
University/Institute: Landspitali - The National University Hospital of Iceland
Department: Faculty of Medicine
Cardio-Vascular Center
Series: Journal of Thoracic and Cardiovascular Surgery; ()
ISSN: 0022-5223
DOI: https://doi.org/10.1016/j.jtcvs.2021.07.011
Subject: Hjartasjúkdómar; Hjartaþelsbólga; aortic root replacement; endocarditis; full root bioprosthesis; reinterventions; survival; type A dissections; Surgery; Pulmonary and Respiratory Medicine; Cardiology and Cardiovascular Medicine
URI: https://hdl.handle.net/20.500.11815/2888

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Citation:

Dagnegård , H H , Bekke , K , Kolseth , S M , Glaser , N , Wallén , C , El-Hamamsy , I , Víðisson , K O , Lie , A S , Valentin , J B , Sartipy , U , Haaverstad , R , Vanky , F , Lefebvre , L , Guðbjartsson , T , Johnsen , S P , Søndergaard , L , Thyregod , G H , Lund , J T , Ihlemann , N & Smerup , M H 2021 , ' Survival after aortic root replacement with a stentless xenograft is determined by patient characteristics ' , Journal of Thoracic and Cardiovascular Surgery . https://doi.org/10.1016/j.jtcvs.2021.07.011

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.

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Publisher Copyright: © 2021 The Authors

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