Hospital Results of a Single Center Database for Stentless Xenograft Use in a Full Root Technique in Over 970 Patients

Abstract

Our aim was to analyse the hospital outcome for the worldwide largest series of stentless bioroot xenografts (Medtronic Freestyle) as full root replacement in a single centre over a period of 18 years. Retrospective data analysis was performed for the entire cohort of patients undergoing aortic root surgery with the Medtronic Freestyle valve prosthesis. Logistic regression analysis was performed to analyse predictors of in-hospital mortality. 971 patients underwent aortic full root replacement with the Medtronic Freestyle valve in the period from 1999–2017, with an average age of 68.8 ± 10.3y and gender distribution of 608:363 (male:female). Concomitant surgery was performed in 693 patients (71.4%). In-hospital all-comers mortality was 9.8% (95 patients), with the respective highest risk profiles including dissections (6.4%), endocarditis (5.6%) and re-do procedures (12.5%). In-hospital mortality for elective patients was 7.6% while isolated aortic root replacement demonstrated a mortality of 3.6%. Logistic regression analysis demonstrated age (OR 1.05, p = 0.005), dissection (OR 5.78, p < 0.001) and concomitant bypass surgery (OR 2.68, p < 0.001) as preoperative risk factors for the entire cohort. Postoperative analysis demonstrated myocardial infarction (OR 48.6, p < 0.001) and acute kidney injury (OR 20.2, p < 0.001) to be independent risk factors influencing mortality. This analysis presents a work-through of all patients with stentless bioroot treatment without positive selection in a high-volume clinical center with the largest experience world-wide for this form of complex surgery. Isolated aortic root replacement could be performed at acceptable operative risk for this technically-challenging procedure.

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

“…The rate of most early complications, including reoperation for bleeding or tamponade, was comparable with previous reports. 2,[9][10][11][14][15][16]18,19,[21][22][23][24][26][27][28][29]31,32,37 However, the number of cerebrovascular events in the type A dissection and endocarditis groups were 22.4% and 10.2%, respectively, compared with up to 10% observed in other studies of these indications. 27,31,32 Some studies included only permanent stroke whereas others did not specify inclusion (eg, transient ischemic attacks or stroke without sequelae).…”

Geometric Changes in Aortic Root Replacement Using Freestyle Prosthesis

“…Indeed, in their systematic review Sherrah et al, reported an in-hospital mortality of 5.2% after Freestyle implantation (10). When our results are placed into perspective, and consideration is made of mortality rates in combined aortic root procedures, high-risk patients, reoperations, or freestyle prosthesis implantation in destructive endocarditis, the outcomes could be considered comparable (11)(12)(13)(14)(15).…”

Aortic root replacement to treat type A aortic dissection: A comparison of midterm outcomes between composite valve grafts and porcine aortic roots

“…Smith et al 20 demonstrated the use of the Medtronic Freestyle bioprosthesis in TAAD with satisfactory early and midterm outcomes in 24 patients, although this was not compared with a valid control. Similarly, larger centers have reported the use of porcine stentless aortic roots as the biological conduit of choice in TAAD with good results 21,22 . Despite this, there is limited evidence comparing the use of porcine stentless aortic bioprosthesis with alternative root surgery in TAAD.…”