Twenty-year experience with stentless biological aortic valve and root replacement: informing patients of risks and benefits†

Schneider, Adriaan W.; Putter, Hein; Hazekamp, Mark G.; Holman, Eduard R.; Bruggemans, Eline F.; Versteegh, Michel I.M.; Schalij, Martin J.; Varkevisser, Rens R.B.; Klautz, Robert J.M.; Braun, Jerry

doi:10.1093/ejcts/ezx478

Cited by 18 publications

(27 citation statements)

References 17 publications

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“…Although pregnancy itself probably does not accelerate deterioration of biologic surgical valve function, the role of pregnancy in a TAVR valve placed in a deteriorated FSB is not known . Furthermore, FSB prostheses in patients younger than 40 years of age appear to deteriorate more rapidly than FSB in patients over 40 years of age . Nevertheless, as has been described in the literature and as evidenced in our patient with a severely stenotic FSB, pregnant women may need repeat intervention during pregnancy for deterioration of a SAVR device .…”

Section: Discussionsupporting

confidence: 59%

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Pregnancy and transcatheter aortic valve replacement in a severely stenotic Freestyle full aortic root stentless bioprosthesis

Zhong¹,

Rokey

Rolak

et al. 2019

Cathet Cardio Intervent

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Symptomatic degenerative prosthetic aortic valve stenosis during pregnancy represents a significant risk to both mother and fetus, and until recently, surgical aortic valve replacement (SAVR) during pregnancy was often the only choice for women opting to continue pregnancy. However, symptomatic severe stenosis in a pregnant woman with a degenerated full aortic root Freestyle stentless bioprosthesis (FSB) and reimplanted coronary arteries presents additional complexities that require an alternative surgical approach. In this case report, we describe the first successful transcatheter aortic valve replacement (TAVR) in SAVR for a severely stenotic degenerative FSB in a pregnant woman and subsequent delivery of a healthy infant several months later. TAVR in SAVR of a severely stenotic aortic FSB should be considered as a surgical option in symptomatic pregnant women. Short-term and long-term implications for future pregnancy should be discussed by a multidisciplinary team and with the patient. K E Y W O R D Saortic stenosis, pregnancy, TAVR in SAVR

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Section: Discussionsupporting

confidence: 59%

“…There is ample literature confirming that structural valve deterioration occurs regardless of pregnancy status in all biologic aortic valves . Long‐term, there is a chance that the TAVR valve and FBS may need to be removed due to worsening TAVR valve stenosis.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy and transcatheter aortic valve replacement in a severely stenotic Freestyle full aortic root stentless bioprosthesis

Zhong¹,

Rokey

Rolak

et al. 2019

Cathet Cardio Intervent

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“…All bioprostheses have the disadvantage of limited durability, especially in younger patients. Patients aged 50 years who undergo a stentless bioprosthetic aortic root replacement have ∼23% probability of requiring reintervention at 15 years [7], compared to ∼8% after mechanical-valved prostheses [8]. The longer durability of mechanical prostheses, however, comes at the cost of a higher life-time risk of thromboembolism and bleeding events (33% for mechanical prostheses vs 17% for bioprostheses) [8, 9].…”

Section: Discussionmentioning

confidence: 99%

“…The mode of failure in degenerated Freestyle prostheses is predominantly leaflet tear, especially in FR implanted prostheses [7]. Although the prosthetic root is often calcified, providing an anchoring point for TAVR prostheses, they often lose their sinus shape and become a straight tube, increasing the chance of coronary obstruction by prosthetic valve leaflets during ViV-TAVR.…”

Section: Discussionmentioning

confidence: 99%

Reinterventions after freestyle stentless aortic valve replacement: an assessment of procedural risks

Schneider

Hazekamp

Versteegh

et al. 2019

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Repeat aortic valve interventions after previous stentless aortic valve replacement (AVR) are considered technically challenging with an increased perioperative risk, especially after full-root replacement. We analysed our experience with reinterventions after stentless AVR. METHODS A total of 75 patients with previous AVR using a Freestyle stentless bioprosthesis (31 subcoronary, 15 root-inclusion and 29 full-root replacement) underwent reintervention in our centre from 1993 until December 2018. Periprocedural data were retrospectively collected from the department database and follow-up data were prospectively collected. RESULTS Median age was 62 years (interquartile range 47–72 years). Indications for reintervention were structural valve deterioration (SVD) in 47, non-SVD in 13 and endocarditis in 15 patients. Urgent surgery was required in 24 (32%) patients. Reinterventions were surgical AVR in 16 (21%), root replacement in 51 (68%) and transcatheter AVR in 8 (11%) patients. Early mortality was 9.3% (n = 7), but decreased to zero in the past decade in 28 patients undergoing elective reoperation. Per indication, early mortality was 9% for SVD, 8% for non-SVD and 13% for endocarditis. Aortic root replacement had the lowest early mortality rate (6%), followed by surgical AVR (13%) and transcatheter AVR (25%, 2 patients with coronary artery obstruction). Pacemaker implantation rate was 7%. Overall survival rate at 10 years was 69% (95% confidence interval 53–81%). CONCLUSIONS Repeat aortic valve interventions after stentless AVR carry an increased, but acceptable, early mortality risk. Transcatheter valve-in-valve procedures after stentless AVR require careful consideration of prosthesis leaflet position to prevent obstruction of the coronary arteries.

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“…In both cohorts, despite different indications for operation, the in-hospital mortality and the survival do not differ signi cantly, also taking into account that concomitant procedures were carried out more often in the non-OA group. As there are 3 patients at risk after 10 years in the non-OA group, we would like to concentrate on the survival at 1 and 5 years which is compareable with current literature including different pathologies and is not showing a signi cant difference between both groups [14,15].…”

Section: Discussionmentioning

confidence: 99%

Freestyle Aortic Root Prosthesis in Combination with Aortic Replacement and Open Anastomosis: A Retrospective Analysis.

Zientara

Rosselet-Droux

Bruijnen

et al. 2021

Preprint

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Background: The Freestyle® bioprosthesis is used for pathologies of the aortic root. Additional resection of the ascending aorta and the proximal arch in dissections or aneurysms might be indicated. The aim was to assess mid-term outcome regarding prosthetic performance, stroke, reoperations, and survival in various pathologies comparing patients with and without additional procedures on the ascending aorta and proximal arch focusing on the standardized technique of unilateral antegrade cerebral perfusion under moderate hypothermia. Methods: Retrospective data analysis of 278 consecutive patients after Freestyle® root replacement between September 2007 and March 2017. Patients were divided in three categories due to the pathology of the aortic root (re-operation vs endocarditis vs dissection). Two groups based on the aortic anastomosis technique (non-open arch anastomosis (non-OA) versus open arch anastomosis (OA)) were compared (119 OA vs 159 non-OA). Cardiovascular risk, previous cardiac events, intra- and postoperative data were evaluated. Inferential statistics were performed with Mann-Whitney U-test. Nominal and categorical variables were tested with Fisher-Freeman-Halton exact test. Kaplan-Meier estimate was used to assess survival.Results: The follow-up rate was 90% (median follow-up: 39.5 months). There were differences in the indication (endocarditis: OA 5 (4.2%) vs non-OA 36 (24%), p<0.0001; dissection: OA 13 (10.9%) vs non-OA 2 (1.3%); p=0.0007). OA patients had less perioperative stroke (1 (1%) vs 15 (10%), p=0.001) and shorter hospital stay (9 vs 12 days, p=0.0004). There were no differences in the mortality (in-hospital: non-OA 8 (5%) vs OA 8 (7%); p=0.6; death at follow-up: non-OA 15 (11%) vs OA 5 (5%); p=0.1). Overall valve performance showed a well-functioning valve in 97.3% at follow-up.Conclusion: The valve performance showed excellent results regardless of the initial indication. The incidence of stroke was lower in patients receiving an open arch anastomosis using unilateral antegrade cerebral perfusion without elevated mortality or prolonged hospital stay.

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Twenty-year experience with stentless biological aortic valve and root replacement: informing patients of risks and benefits†

Cited by 18 publications

References 17 publications

Pregnancy and transcatheter aortic valve replacement in a severely stenotic Freestyle full aortic root stentless bioprosthesis

Pregnancy and transcatheter aortic valve replacement in a severely stenotic Freestyle full aortic root stentless bioprosthesis

Reinterventions after freestyle stentless aortic valve replacement: an assessment of procedural risks

Freestyle Aortic Root Prosthesis in Combination with Aortic Replacement and Open Anastomosis: A Retrospective Analysis.

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