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Ten-year experience with stentless aortic valves : full-root versus subcoronary implantation

Ennker, J. A. and Albert, A. A. and Rosendahl, U. P. and Ennker, I. C. and Dalladaku, F. and Florath, I.. (2008) Ten-year experience with stentless aortic valves : full-root versus subcoronary implantation. The annals of thoracic surgery, Vol. 85. pp. 445-452.

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Official URL: http://edoc.unibas.ch/dok/A6005540

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Abstract

BACKGROUND: We compared the midterm outcome after aortic valve replacement with the Freestyle stentless bioprosthesis for the full-root or subcoronary implantation technique, while adjusting for patient and disease characteristics by a propensity score. METHODS: Between 1996 and 2005, 1,014 patients underwent aortic valve replacement with the stentless Medtronic Freestyle bioprosthesis, 168 using full-root technique. Based on a saturated propensity score, 148 matched pairs were created. Mean age of the 296 patients was 73 +/- 3 years. Mean follow-up time was 32 +/- 30 months (maximum, 116 months). RESULTS: Operative mortality was 4.7% and 2.7% (p = 0.36) in the full-root and subcoronary groups, respectively. Freedom from reoperation, prosthetic valve endocarditis, major bleeding, and thromboembolism after 9 years was 98% +/- 1% and 90% +/- 7% (p = 0.38), 95% +/- 3% and 92% +/- 7% (p = 0.76), 72% +/- 21% and 98% +/- 2% (p = 0.12), and 75% +/- 8% and 84% +/- 7% (p = 0.28), for full-root and subcoronary groups, respectively. Survival rates after 9 years were 34% +/- 24% and 33% +/- 11% (p = 0.46), for the full-root and subcoronary groups, respectively. Patients in the full-root group received larger valve sizes (p = 0.03), and the mean transprosthetic gradients at discharge were significantly lower for each valve size. Nevertheless, during follow-up, peak gradients decreased to a greater extent in patients presenting high peak gradients (<36 mm Hg) at discharge. CONCLUSIONS: As risk-adjusted comparison of both implantation techniques did not reveal any differences regarding operative and midterm outcomes, full-root replacement can be liberally performed in patients with small aortic roots, annuloaortic ectasia, or requiring replacement of ascending aorta.
Faculties and Departments:03 Faculty of Medicine > Bereich Operative Fächer (Klinik) > Innere Organe
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Operative Fächer (Klinik) > Innere Organe
UniBasel Contributors:Ennker, Jürgen
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:Little Brown
ISSN:0003-4975
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:08 Nov 2012 16:23
Deposited On:08 Nov 2012 16:16

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