Safety and Outcomes of Redo Aortic Valve Surgery Following Aortic Full Root Replacement with Stentless Medtronic Freestyle Prosthesis

Background: This study aims to evaluate the safety and outcomes of redo aortic valve surgery in patients who previously underwent full root replacement with a Freestyle stentless prosthesis. We analyzed the indications for reoperation, surgical approaches, and postoperative outcomes to derive insights from our institutional experience.

Methods: Out of 970 patients who underwent an aortic full root replacement with a Freestyle stentless prosthesis, a retrospective analysis was conducted on 38 patients who underwent redo aortic valve surgery after prior full root replacement between 2006 and 2024. Patient data, including demographics, operative details, and postoperative outcomes, were collected from the departmental database. Key variables assessed included the time to redo surgery, indications for reintervention (SVD, non-SVD, or endocarditis), preoperative NYHA classification, urgency of surgery, type and size of the implanted prosthesis, cross-clamp time, and postoperative morbidity and mortality.

Results: The cohort included 24 males and 14 females with a mean age of 64.2 years (IQR 10.5 years). The average time to redo surgery was 10.3 years. Indications for reintervention were predominantly SVD (55.3%), followed by active endocarditis (42%). Urgent surgery was required in 44.7% of cases. The majority of reoperations involved the implantation of sutureless prostheses (52.6%) including Perceval, Enable, and Intuity, with sizes ranging from 21 to 27 mm. Redo full root replacement was performed in 13 patients all of whom survived well except one who died with double valve endocarditis. The average cross-clamp time was 87.1 minutes, and the postoperative aortic valve P mean averaged 13.5 mm Hg. Three patients needed ECLS postoperatively despite using rapid deployment valves and a total of 4 patients died within 30 days due to massive intracranial bleeding, sepsis, and multiorgan failure. Cross-clamp time showed no significant correlation with higher mortality.

Conclusion: Redo aortic valve surgery following Freestyle stentless full root replacement is associated with acceptable outcomes, though the complexity of cases, particularly those involving endocarditis and urgent surgery, poses significant risks. The choice of prosthesis, along with careful management of cross-clamp time, is crucial in minimizing postoperative complications. Our findings underscore the importance of tailored surgical strategies to optimize patient outcomes in this challenging clinical scenario.

Publication History

Article published online:
11 February 2025