Andrew G Sherrah1, Richmond W Jeremy2, Rajesh Puranik3, Paul G Bannon4, P Nicholas Hendel5, Matthew S Bayfield5, Michael K Wilson6, Peter W Brady7, David Marshman7, Manu N Mathur7, R John Brereton7, James R Edwards8, Robert G Stuklis8, Michael Worthington8, Michael P Vallely9. 1. Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia. 2. Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. 3. Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia. 4. Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia. 5. The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia. 6. The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia. 7. Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, NSW, Australia. 8. Darcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia. 9. Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia. Electronic address: michael.vallely@sydneyheartandlung.com.au.
Abstract
BACKGROUND: The Freestyle stentless bioprosthesis (FSB) has been demonstrated to be a durable prosthesis in the aortic position. We present data following Freestyle implantation for up to 10 years post-operatively and compare this with previously published results. METHODS: A retrospective cohort analysis of 237 patients following FSB implantation occurred at five Australian hospitals. Follow-up data included clinical and echocardiographic outcomes. RESULTS: The cohort was 81.4% male with age 63.2±13.0 years and was followed for a mean of 2.4±2.3 years (range 0-10.9 years, total 569 patient-years). The FSB was implanted as a full aortic root replacement in 87.8% patients. The 30-day all cause mortality was 4.2% (2.0% for elective surgery). Cumulative survival at one, five and 10 years was 91.7±1.9%, 82.8±3.8% and 56.5±10.5%, respectively. Freedom from re-intervention at one, five and 10 years was 99.5±0.5%, 91.6±3.7% and 72.3±10.5%, respectively. At latest echocardiographic review (mean 2.3±2.1 years post-operatively), 92.6% had trivial or no aortic regurgitation. Predictors of post-operative mortality included active endocarditis, acute aortic dissection and peripheral vascular disease. CONCLUSIONS: We report acceptable short and long term outcomes following FSB implantation in a cohort of comparatively younger patients with thoracic aortic disease. The durability of this bioprosthesis in the younger population remains to be confirmed.
BACKGROUND: The Freestyle stentless bioprosthesis (FSB) has been demonstrated to be a durable prosthesis in the aortic position. We present data following Freestyle implantation for up to 10 years post-operatively and compare this with previously published results. METHODS: A retrospective cohort analysis of 237 patients following FSB implantation occurred at five Australian hospitals. Follow-up data included clinical and echocardiographic outcomes. RESULTS: The cohort was 81.4% male with age 63.2±13.0 years and was followed for a mean of 2.4±2.3 years (range 0-10.9 years, total 569 patient-years). The FSB was implanted as a full aortic root replacement in 87.8% patients. The 30-day all cause mortality was 4.2% (2.0% for elective surgery). Cumulative survival at one, five and 10 years was 91.7±1.9%, 82.8±3.8% and 56.5±10.5%, respectively. Freedom from re-intervention at one, five and 10 years was 99.5±0.5%, 91.6±3.7% and 72.3±10.5%, respectively. At latest echocardiographic review (mean 2.3±2.1 years post-operatively), 92.6% had trivial or no aortic regurgitation. Predictors of post-operative mortality included active endocarditis, acute aortic dissection and peripheral vascular disease. CONCLUSIONS: We report acceptable short and long term outcomes following FSB implantation in a cohort of comparatively younger patients with thoracic aortic disease. The durability of this bioprosthesis in the younger population remains to be confirmed.
Authors: Bo Yang; Aroosa Malik; Linda Farhat; Alexander Makkinejad; Elizabeth L Norton; Mohamed-Ali Sareini; Emma St Pierre; Xiaoting Wu; Jonathan Haft; Matthew Romano; Steven F Bolling; Himanshu J Patel; G Michael Deeb Journal: Ann Thorac Surg Date: 2019-12-23 Impact factor: 4.330