Evaluate outcomes of the Freestyle stentless aortic bioprosthesis in patients 60 years
old and younger. All patients, 60 years old and younger, between January 1, 1998 to
December 31, 2015 who underwent implantation of a Freestyle aortic valve at a single
institution were reviewed. Medical records and telephone interviews were utilized
for data collection. 515 patients were identified with an average age of 51.3 years.
Mean follow up was 11.1 years. 225 full root replacements and 290 subcoronary implants
were performed. Overall survival, including patients with concomitant procedures,
at 15 years was 63.7% (95% CI 58.3-68.5). Isolated subcoronary implants (58%,167/290)
had a 15-year survival of 71.6% (95% CI 62.6-78.7) vs 78.4% (95% CI 69.7, 84.9) for
isolated root replacements (63%,141/225) which was not statistically significant (P = 0.397). No significant difference in operative SVD at 15 years occurred between
full root replacements 37.6% (95% CI 27.2-50.2) vs subcoronary implants 39.4% (95%
CI31.1, 49.0). 110 patients required reoperation solely for intrinsic SVD. 93% (102/110)
failed due to aortic insufficiency. Of reoperative interventions for SVD, 37% (41/110)
of patients required urgent reoperation and 4.5% (5/110) required emergent reoperation.
Pseudoaneurysms developed in six of the full root replacements. Freestyle aortic valves
have a high rate of acute failure requiring urgent or emergent reintervention in patients
60 years old and younger. This has led our group to shift practice away from their
implantation.
Graphical abstract
Graphical Abstract
Keywords
Abbreviation:
SVD (structural valve deterioration), TAVR (Transcatheter aortic valve replacement), FR (full root replacement), SC (subcoronary implant)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 08, 2021
Footnotes
The Institutional Review Board (IRB) of Spectrum Health approved the study protocol and publication of data on November 16, 2020 (project number: 2011-071-SH/HDVCH). Patient written consent for the publication of the study was waived by the IRB.
Funding: This study did not receive any outside funding. Statistical support was provided by the Frederik Meijer Heart and Vascular Institute.
Conflicts of Interest: The authors have no conflict of interest.
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Access this article on ScienceDirectLinked Article
- Commentary: The Shrinking Role of the Freestyle Aortic Bioprostheses in Younger PatientsSeminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
- PreviewIn this issue of Seminars in Thoracic and Cardiovascular Surgery, Khazaal and colleagues from Grand Rapids present their single center long-term experience with the Freestyle porcine bioprosthesis (Medtronic Inc., Minneapolis MN) in younger patients.1 Since its FDA-approval in 1997, the Freestyle bioprosthesis has become part of the armamentarium for aortic valve and aortic root replacement. Like other stentless bioprostheses, the main advantage it offers is favorable hemodynamics due to larger effective orifice area.
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