Medtronic Freestyle in 971 patients over a 18 year time period: the Oldenburg Experience
Jerry Easo1, Alexander Weymann1, Marcin Szczechowicz1, Philipp Hölzl2, Ahmed Mashhour1, Konstantin Zhigalov1, Michael Horst1, Harald Eichstaedt1, Juergen Ennker1, Otto Dapunt3.
1University Hospital Oldenburg, Oldenburg, Germany, 2Helios Hospital Siegburg, Siegburg, Germany, 3Medical University of Graz, Graz, Austria.
OBJECTIVE: To analyse the hospital outcome for the worldwide largest series of stentless xenografts implanted in a full root technique in a single center over a period of 18 years, analysing the operative results and postoperative outcome.
METHODS: Retrospective data analysis was performed for the entire cohort of patients undergoing stentless bioroot surgery with the Medtronic Freestyle valve. Thorough statistical analysis was obtained to calculate vital clinical data, including mortality and complication rate among others. Logistic regression analysis was used to analyze predictors of in-hospital mortality
RESULTS: 971 patients underwent aortic valve surgery (951 as full-root and 20 as Subcoronary valve replacement) with the Medtronic Freestyle valve over a time period from 1999-2017 with an average age of 68.8 ±10.3y and gender distribution 608:363 (m:f). 49.2% suffered under aneurysm of the ascending aorta, concomitant surgery was performed in 693 patients (71.4%), including bypass surgery, ascending and/or arch replacement, mitral valve surgery and many others. The in-hospital mortality was 95/972 (9.8%), presenting all comers with the respective highest risk profile including dissections (6.4% of all patients), endocarditis (5.6% of all patients) and re-do's (12.5% of all patients). Emergent surgical indication was present for 119 patients (12.3%). Hospital mortality for elective patients was 7.6%, isolated aortic valve replacement as stand-alone primary procedure demonstrated a mortality of 3.6%. Logistic regression analysis demonstrated age (OR 1.05, p=0.006), dissection (OR 5.78, p<0.001), CABG (OR 2.68, p<0.001) as preoperative risk factors, among others. Postoperative analysis demonstrated myocardial infarction (OR 48.6, p<0.001), acute kidney injury (OR 20.2, p<0.001) among others to be independent predictors of mortality.
This analysis presents an honest work-through of all patients with stentless bioroot treatment without positive selection, demonstrating adequate hospital results for patients presenting with highest risk profile in a high volume clinical center with the largest experience world-wide for this form of complex surgery. Stand-alone isolated aortic valve replacement could be performed at low operative risk for this technically challenging procedure.
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