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Freestyle Aortic Bioprostheses in Patients 60 Years old and Younger

      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

      Keywords

      Abbreviation:

      SVD (structural valve deterioration), TAVR (Transcatheter aortic valve replacement), FR (full root replacement), SC (subcoronary implant)
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      References

        • Bach D.S.
        • Kon N.D.
        • Dumesnil J.G.
        • Sintek C.F.
        • Doty D.B.
        Ten-year outcome after aortic valve replacement with the freestyle stentless bioprosthesis.
        Ann Thor Surg. 2005; 80: 480-487
        • Dumesnil J.G.
        • LeBlanc M.
        • Cartier P.C.
        • Doyle D.P.
        • Lemieux M.D.
        • Raymond G.
        Hemodynamic features of the freestyle aortic bioprosthesis compared with stented bioprosthesis.
        Ann Thor Surg. 1998; 66: S130-S133
        • Pibarot P.
        • Dumesnil J.G.
        • Jobin J.
        • Cartier P.
        • Honos G.
        • Durand L.G.
        Hemodynamic and physical performance during maximal exercise in patients with an aortic bioprosthetic valve.
        J Am Coll Card. 1999; 34: 1609-1617
        • Kunadian B.
        • Vijayalakshmi K.
        • Thornley A.R.
        • deBelder M.A.
        • Hunter S.
        • Kendall S.
        • et al.
        Meta-analysis of valve hemodynamics and left ventricular mass regression for stentless vs stented aortic valves.
        Ann Thor Surg. 2007; 84: 73-78
        • Nishimura R.A.
        • Bonow R.O.
        • Carabello B.A.
        • Erwin J.P.
        • Fleisher L.A.
        • Jneid H.
        • et al.
        2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease.
        J Am Coll Card. 2017; 70: 254-289
        • van Geldorp M.W.A.
        • Jamieson W.R.E.
        • Kappetein A.P.
        • Grunkmeier G.L.
        • Bogers J.J.C.
        • Takkenber J.M.
        Patient outcome after aortic valve replacement with a mechanical or biologic prosthesis: weighing lifetime anticoagulant-related event risk against reoperation.
        J Thor Cardiovasc Surg. 2009; 137: 881-885
        • Nishimura R.A.
        • Otto C.
        • Bonow R.O.
        • Carabello B.A.
        • Erwin J.P.
        • Guyton R.A.
        • et al.
        2014 HAH/ACC guideline for the anagement of patietns with valvular heart disease: executive summary.
        Circul. 2014; 130: 2440-2492
        • Yang B.
        • Malik A.
        • Farhat L.
        • Makkinejad A.
        • Norton E.L.
        • Sareini M.A.
        • et al.
        Influence of age on longevity of a stentless aortic valve.
        Ann Thor Surg. 2020; 110: 500-507
        • Bourguignon T.
        • Lhommet P.
        • El Khoury R.
        • Candolfi P.
        • Loardi C.
        • Mirza A.
        • et al.
        Very long-term outcomes of the Carpentier-Edwards perimount aortic valve in patietns aged 50-65 years.
        Eur J Cardiothorac Surg. 2016; 49: 1462-1468
        • Une D.
        • Ruel M.
        • David T.E.
        Twenty-year durability of the aortic Hancock II bioprsthesis in young patients: is it durable enough?.
        Eur J Cardiothorac Surg. 2014; 46: 825-830
        • Forcillo J.
        • Haamsy I.E.
        • Stevens L.M.
        • Badrudin D.
        • Pellerin M.
        • Perrault L.P.
        • et al.
        the perimount valve in the aortic position: twenty-year experience with patients under 60 years old.
        Ann Thor Surg. 2014; 97: 1526-1532
        • Iribame A.
        • Leavitt B.J.
        • Robich M.P.
        • Sardella G.L.
        • Gelb D.J.
        • Baribeau Y.R.
        • et al.
        Tissue vs mechanical aortic valve replacement in younger patients: a multicenter analysis.
        J Thor Cardiovasc Surg. 2019; 158: 1529-1538
        • Schnittman S.R.
        • Adams D.H.
        • Itagaki S.
        • Toyoda N.
        • Egorova N.N.
        • Chikwe J.
        Bioprosthetic aortic valve replacement: revisiting prosthesis choice in patients younger than 50 years old.
        J Thorac Cardiovasc Surg. 2018; 155: 539-547
        • Arias E.
        • Xu J.
        National Vital Statistics Reports. 2019; 68: 4
        • Welke K.F.
        • Wu Y.
        • Grunkemeier G.L.
        • Ahamad A.
        • Starr A.
        Long-term results after Capentier-Edwards pericardial valve implantation, with attention to age.
        Heart Surg Forum. 2011; 14: 160-165
        • Chan V.
        • Malas T.
        • Lapierre H.
        • Boodhwani M.
        • Lam B.
        • Reubens F.D.
        • et al.
        Reoperation of left heart valve bioprosthesis according to age at implantation.
        Circul. 2001; 124: 75-80
        • Bourguignon T.
        • Bouquiaux-Stablo A.L.
        • Pascal C.
        • Mirza A.
        • Loardi C.
        • May M.A.
        • et al.
        Very long-term outcomes of the Carpentier-Edwards perimount valve in aortic position.
        Ann Thor Surg. 2015; 99: 831-837
        • Mohammadi S.
        • Kalavrouziotis D.
        • Voisine P.
        • Dumont E.
        • Doyle D.
        • Perron J.
        • et al.
        Bioprosthetic valve durability after stentless aortic valve replacement: the effect of implantation technique.
        Ann Thorac Surg. 2014; 97: 2011-2018
        • Schneider A.W.
        • Hazekamp M.G.
        • Versteegh M.I.M.
        • de Weger A.
        • Holman E.R.
        • Klautz R.J.M.
        • et al.
        Reinterventions after freestyle stentless aortic valve replacement: an assessment of procedural risks.
        Eur J Cardiothorac Surg. 2019; 56: 1117-1123
        • Yang B.
        • Patel H.J.
        • Norton E.L.
        • Debenedictus C.
        • Hornsby W.E.
        • Likosky D.S.
        • Deeb G.M.
        Aortic valve reoperation after stentless bioprosthesis: short -and long-term outcomes.
        Ann Thorac Surg. 2018; 106: 521-525
        • Mohammadi S.
        • Baillot R.
        • Voisine P.
        • Mathieu P.
        • Dagenais F.
        Structural deterioration of the Freestyle aortic valve: mode of presentation and mechanisms.
        J Thor Cardiovasc Surg. 2006; 132: 401-406
        • Grunkemeier G.L.
        • Furnay A.P.
        • Wu Y.X.
        • Wang L.
        • Starr A.
        Durability of pericardial vs porcine bioprosthetic heart valves.
        J Thor Cardiovasc Surg. 2012; 144: 1381-1386
        • Nalluri N.
        • Atti V.
        • Munir A.B.
        • et al.
        Valve in valve transcatheter aortic valve implantation (ViV-TAVI) vs redo-Surgical aortic valve replacement (redo-SAVR): A systematic review and meta-analysis.
        J Interv Cardiol. 2018; 31: 661-671https://doi.org/10.1111/joic.12520
        • Sang S.L.W.
        • Beute T.
        • Heiser J.
        • Berkompas D.
        • Fanning J.
        • Merhi W.
        Early Outcomes for Valve-in-valve Transcatheter Aortic Valve Replacement in Degenerative Freestyle Bioprostheses.
        Semin Thorac Cardiovasc Surg. 2018; 30: 262-268https://doi.org/10.1053/j.semtcvs2017.11.001
        • Gozdek M.
        • Raffa G.M.
        • Suwalski P.
        • et al.
        Comparative performance of transcatheter aortic valve-in-valve implantation vs conventional surgical redo aortic valve replacement in patients with degenerated aortic valve bioprostheses: systematic review and meta-analysis.
        Eur J Cardiothorac Surg. 2018; 53: 495-504https://doi.org/10.1093/ejcts/ezx347
        • Edelman J.J.
        • Khan J.M.
        • Rogers T.
        • et al.
        Valve-in-Valve TAVR: State-of-the-Art Review.
        Innovations (Phila). 2019; 14: 299-310https://doi.org/10.1177/1556984519858020
        • Englum B.R.
        • Pavlisko E.N.
        • Mack M.C.
        • Schechter M.A.
        • Hanna J.M.
        • Hughes G.C.
        Pseudoaneurysm formation after Medtronic Freestyle porcine aortic bioprosthesis implantation: a word of caution.
        Ann Thorac Surg. 2014; 98: 2061-2067

      Linked Article

      • Commentary: The Shrinking Role of the Freestyle Aortic Bioprostheses in Younger Patients
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
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          In 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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