TY - JOUR
T1 - Survival after aortic root replacement with a stentless xenograft is determined by patient characteristics
AU - Dagnegård, Hanna H.
AU - Bekke, Kirstine
AU - Kolseth, Solveig M.
AU - Glaser, Natalie
AU - Wallén, Christoffer
AU - El-Hamamsy, Ismail
AU - Vidisson, Kristjan O.
AU - Lie, Asbjørn S.
AU - Valentin, Jan B.
AU - Sartipy, Ulrik
AU - Haaverstad, Rune
AU - Vanky, Farkas
AU - Lefebvre, Laurence
AU - Gudbjartsson, Tomas
AU - Johnsen, Søren P.
AU - Søndergaard, Lars
AU - Thyregod, Gustav H.
AU - Lund, Jens T.
AU - Ihlemann, Nikolaj
AU - Smerup, Morten H.
N1 - Publisher Copyright:
© 2021 The Authors
PY - 2022/12
Y1 - 2022/12
N2 - 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.
AB - 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.
KW - aortic root replacement
KW - endocarditis
KW - full root bioprosthesis
KW - reinterventions
KW - survival
KW - type A dissections
UR - http://www.scopus.com/inward/record.url?scp=85113240826&partnerID=8YFLogxK
U2 - 10.1016/j.jtcvs.2021.07.011
DO - 10.1016/j.jtcvs.2021.07.011
M3 - Article
AN - SCOPUS:85113240826
SN - 0022-5223
VL - 164
SP - 1712-1724.e10
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 6
ER -