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Dagnegård HSH, Sigvardsen PE, Ihlemann N, et al. Structural abnormalities after aortic root replacement with stentless xenograft. J Thorac Cardiovasc Surg. 2021;doi: 10.1016/j.jtcvs.2021.04.087.
Dagnegård, H. S. H., Sigvardsen, P. E., Ihlemann, N., Kofoed, K. F., El-Hamamsy, I., Bekke, K., Valentin, J. B., Lefebvre, L., Johnsen, S. P., Søndergaard, L., Lund, J. T., & Smerup, M. H. (2021). Structural abnormalities after aortic root replacement with stentless xenograft. The Journal of thoracic and cardiovascular surgery, . https://doi.org/10.1016/j.jtcvs.2021.04.087
Dagnegård, Hanna Sofia Holmgren, et al. "Structural abnormalities after aortic root replacement with stentless xenograft." The Journal of thoracic and cardiovascular surgery vol. (2021). doi: https://doi.org/10.1016/j.jtcvs.2021.04.087
Dagnegård HSH, Sigvardsen PE, Ihlemann N, Kofoed KF, El-Hamamsy I, Bekke K, Valentin JB, Lefebvre L, Johnsen SP, Søndergaard L, Lund JT, Smerup MH. Structural abnormalities after aortic root replacement with stentless xenograft. J Thorac Cardiovasc Surg. 2021 May 12; doi: 10.1016/j.jtcvs.2021.04.087. Epub 2021 May 12. PMID: 34116854.
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J Thorac Cardiovasc Surg. 2021 May 12; doi: 10.1016/j.jtcvs.2021.04.087. Epub 2021 May 12.

Structural abnormalities after aortic root replacement with stentless xenograft.

The Journal of thoracic and cardiovascular surgery

Hanna Sofia Holmgren Dagnegård, Per Ejlstrup Sigvardsen, Nikolaj Ihlemann, Klaus Fuglsang Kofoed, Ismail El-Hamamsy, Kirstine Bekke, Jan Brink Valentin, Laurence Lefebvre, Søren Paaske Johnsen, Lars Søndergaard, Jens Teglgaard Lund, Morten Holdgaard Smerup

Affiliations

  1. Department of Cardiothoracic Surgery, The Heart Center, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Department of Cardiology, The Heart Center, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark. Electronic address: [email protected].
  2. Department of Cardiology, The Heart Center, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
  3. Department of Cardiology, The Heart Center, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark; Department of Radiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
  4. Department of Cardiac Surgery, Montreal Heart Institute, Université de Montreal, Montreal, Quebec, Canada.
  5. Department of Cardiothoracic Surgery, The Heart Center, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
  6. Department of Clinical Medicine, Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark.
  7. Department of Cardiology, The Heart Center, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark.
  8. Cardio Thoracic Surgical Department, Green Lane Division, Auckland City Hospital, Auckland, New Zealand.
  9. Department of Cardiothoracic Surgery, The Heart Center, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark.

PMID: 34116854 DOI: 10.1016/j.jtcvs.2021.04.087

Abstract

OBJECTIVE: In complex and high-risk aortic root disease, the porcine Freestyle stentless bioprosthesis (Medtronic Inc, Minneapolis, Minn) is an important surgical treatment option. We aimed to determine prevalence and clinical effect of structural and functional abnormalities after full-root Freestyle implantation.

METHODS: Our cross-sectional 2-center study combined with clinical follow-up included 253 patients with full-root Freestyle bioprostheses implanted from 1999 to 2017. Patients underwent transthoracic echocardiography (TTE) and contrast-enhanced, electrocardiogram-gated 4-dimensional cardiac computed tomography (4DCT) at median age 70 (interquartile range, 62-75) years. After 4DCT, clinical follow-up continued throughout 2018. Median follow-up was 3.3 years before 4DCT and 1.4 years after.

RESULTS: We identified abnormalities in 46% of patients, including pseudoaneurysms (n = 32; 13%), moderate or severe coronary ostial stenosis (n = 54; 21%), and moderate-severe leaflet thickening or reduced leaflet motion (n = 51; 20%). TTE only identified 1 patient with pseudoaneurysm. After 4DCT, the unadjusted hazard ratio for surgical reintervention among patients with abnormal 4DCT was 4.2 (95% confidence interval, 1.2-15.3), in all, 10% required a reintervention. 4DCT abnormalities were associated with a statistically nonsignificant increased risk of death, stroke, or myocardial infarction (hazard ratio obtained using Cox proportional hazards regression analysis, 2.4; 95% confidence interval, 0.7-7.6). In all, 4.0% died, 3.6% had a myocardial infarction, and 2.0% had a stroke.

CONCLUSIONS: Structural and functional abnormalities of the aortic root are frequent after Freestyle implantation and TTE appears to be insufficient for follow-up. Abnormalities might be associated with increased risk of reintervention and potentially adverse clinical outcomes. Longer follow-up and larger study populations are needed to further clarify the clinical implications of abnormalities identified with 4DCT.

Copyright © 2021 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Keywords: aortic root replacement; coronary ostial stenosis; leaflet abnormalities; pseudoaneurysm; reimplanted coronaries; stentless Freestyle bioprosthesis

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