Are Aortic Valve Reoperations after Primary Replacement with Stentless Heart Valve Prostheses More Demanding than after Stented Biological Prostheses?
20 September 2013
24 December 2013
01 May 2014 (online)
Objective Reoperations after aortic valve replacement (AVR) with stentless valve prostheses are believed to be surgically more difficult than after stented prostheses.
Methods Between January 1996 and December 2006, 1,340 of 3,785 patients with AVR in a single institution received a stentless valve prosthesis in aortic position (Medtronic Freestyle, Medtronic GmbH, Meerbusch, Germany). Reoperations after stentless AVR occurred in 27 patients (2.0%). Twenty-four of these patients were compared with another 24 patients having redo surgery after a primary stented bioprosthesis after carrying out propensity score matching.
Results After matching, stentless valve redo patients had a similar preoperative risk profile regarding EuroSCORE (stentless 10 ± 3 points/stented 11 ± 3 points; p = 0.37), preoperative active endocarditis (stentless 37.5%/stented 16.7%; p = 0.081), and amount of concomitant procedures (stentless 37.5%/stented 16.7%; p = 0.222). Thirty-day mortality after reoperation was 20.8% (5 patients) in the stentless and 4.2% (1 patient) in the stented group (p = 0.081), and reintubation rate was 16.7% in the stentless and 0% in the stented group (p = 0.037). Aortic clamping time (stentless 90 ± 25 min/stented 86 ± 34 min; p = 0.208) and extracorporeal circulation time (stentless 151 ± 59 min/stented 132 ± 52 min; p = 0.55) were similar in both groups.
Conclusion Our data do not show that the technical difficulty of reoperations after stentless AVR is higher than that of reoperations after stented AVR. The clinically visible, but not statistically significant, higher early mortality rate of our stentless group is mainly due to more active valve prosthesis endocarditis cases and a higher amount of concomitant procedures.
- 1 Bach DS, Kon ND, Dumesnil JG, Sintek CF, Doty DB. Ten-year outcome after aortic valve replacement with the freestyle stentless bioprosthesis. Ann Thorac Surg 2005; 80 (2) 480-486 , discussion 486–487
- 2 Mohammadi S, Baillot R, Voisine P, Mathieu P, Dagenais F. Structural deterioration of the Freestyle aortic valve: mode of presentation and mechanisms. J Thorac Cardiovasc Surg 2006; 132 (2) 401-406
- 3 Deleuze PH, Fromes Y, Khoury W, Maribas P, Lemaire S, Bical OM. Eight-year results of Freestyle stentless bioprosthesis in the aortic position: a single-center study of 500 patients. J Heart Valve Dis 2006; 15 (2) 247-252
- 4 Ennker JA, Albert AA, Rosendahl UP, Ennker IC, Dalladaku F, Florath I. Ten-year experience with stentless aortic valves: full-root versus subcoronary implantation. Ann Thorac Surg 2008; 85 (2) 445-452 , discussion 452–453
- 5 Ennker JA, Ennker IC, Albert AA, Rosendahl UP, Bauer S, Florath I. The Freestyle stentless bioprosthesis in more than 1000 patients: a single-center experience over 10 years. J Card Surg 2009; 24 (1) 41-48
- 6 Borger MA, Carson SM, Ivanov J , et al. Stentless aortic valves are hemodynamically superior to stented valves during mid-term follow-up: a large retrospective study. Ann Thorac Surg 2005; 80 (6) 2180-2185
- 7 O'Brien MF. Heterograft aortic valves for human use. Valve bank, techniques of measurement, and implantation. J Thorac Cardiovasc Surg 1967; 53 (3) 392-397
- 8 Doty DB, Doty JR. Stentless aortic valve replacement: bioprostheses. In: Cohn LH, Edmunds LH, , eds. Cardiac Surgery in the Adult. New York: McGraw-Hill; 2003: 889-898
- 9 Akins CW, Miller DC, Turina MI , et al; Councils of the American Association for Thoracic Surgery; Society of Thoracic Surgeons; European Association for Cardio-Thoracic Surgery; Ad Hoc Liaison Committee for Standardizing Definitions of Prosthetic Heart Valve Morbidity. Guidelines for reporting mortality and morbidity after cardiac valve interventions. J Thorac Cardiovasc Surg 2008; 135 (4) 732-738
- 10 Lacour-Gayet F, Clarke D, Jacobs J , et al; Aristotle Committee. The Aristotle score: a complexity-adjusted method to evaluate surgical results. Eur J Cardiothorac Surg 2004; 25 (6) 911-924
- 11 Finch J, Roussin I, Pepper J. Failing stentless aortic valves: redo aortic root replacement or valve in a valve?. Eur J Cardiothorac Surg 2013; 43 (3) 495-504
- 12 Borger MA, Prasongsukarn K, Armstrong S, Feindel CM, David TE. Stentless aortic valve reoperations: a surgical challenge. Ann Thorac Surg 2007; 84 (3) 737-743 , discussion 743–744
- 13 Jamieson WR, Burr LH, Miyagishima RT , et al. Re-operation for bioprosthetic aortic structural failure - risk assessment. Eur J Cardiothorac Surg 2003; 24 (6) 873-878
- 14 Davierwala PM, Borger MA, David TE, Rao V, Maganti M, Yau TM. Reoperation is not an independent predictor of mortality during aortic valve surgery. J Thorac Cardiovasc Surg 2006; 131 (2) 329-335
- 15 Vogt PR, Brunner-LaRocca H, Sidler P , et al. Reoperative surgery for degenerated aortic bioprostheses: predictors for emergency surgery and reoperative mortality. Eur J Cardiothorac Surg 2000; 17 (2) 134-139
- 16 Akins CW, Buckley MJ, Daggett WM , et al. Risk of reoperative valve replacement for failed mitral and aortic bioprostheses. Ann Thorac Surg 1998; 65 (6) 1545-1551 , discussion 1551–1552
- 17 Gabbieri D, Dohmen PM, Linneweber J , et al. Early outcome after surgery for active native and prosthetic aortic valve endocarditis. J Heart Valve Dis 2008; 17 (5) 508-524 , discussion 525
- 18 Aranki SF, Santini F, Adams DH , et al. Aortic valve endocarditis. Determinants of early survival and late morbidity. Circulation 1994; 90 (5, Pt 2) II175-II182