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Original Articles: Cardiovascular

Ten-Year Experience With Stentless Aortic Valves: Full-Root Versus Subcoronary Implantation

^a Department of Cardiothoracic Surgery, Heart Institute Lahr/Baden, Lahr
^b Institute of Cardiovascular Medicine of the University Witten-Herdecke, Witten, Germany

Accepted for publication October 2, 2007.

^_* Address correspondence to Dr Florath, Heart Institute Lahr/Baden, Hohbergweg 2, Lahr, D-77933, Germany (Email: ines.florath{at}heart-lahr.com).

Presented at the Forty-third Annual Meeting of The Society of Thoracic Surgeons, San Diego, CA, Jan 29–31, 2007.

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.