Structural abnormalities after aortic root replacement with stentless xenograft
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Structural abnormalities after aortic root replacement with stentless xenograft. / Dagnegård, Hanna Sofia Holmgren; Sigvardsen, Per Ejlstrup; Ihlemann, Nikolaj; Kofoed, Klaus Fuglsang; El-Hamamsy, Ismail; Bekke, Kirstine; Valentin, Jan Brink; Lefebvre, Laurence; Johnsen, Søren Paaske; Søndergaard, Lars; Lund, Jens Teglgaard; Smerup, Morten Holdgaard.
I: Journal of Thoracic and Cardiovascular Surgery, Bind 165, Nr. 4, 2023, s. 1285-1297.e6.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Structural abnormalities after aortic root replacement with stentless xenograft
AU - Dagnegård, Hanna Sofia Holmgren
AU - Sigvardsen, Per Ejlstrup
AU - Ihlemann, Nikolaj
AU - Kofoed, Klaus Fuglsang
AU - El-Hamamsy, Ismail
AU - Bekke, Kirstine
AU - Valentin, Jan Brink
AU - Lefebvre, Laurence
AU - Johnsen, Søren Paaske
AU - Søndergaard, Lars
AU - Lund, Jens Teglgaard
AU - Smerup, Morten Holdgaard
N1 - Publisher Copyright: © 2021 The American Association for Thoracic Surgery
PY - 2023
Y1 - 2023
N2 - 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.
AB - 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.
KW - aortic root replacement
KW - coronary ostial stenosis
KW - leaflet abnormalities
KW - pseudoaneurysm
KW - reimplanted coronaries
KW - stentless Freestyle bioprosthesis
U2 - 10.1016/j.jtcvs.2021.04.087
DO - 10.1016/j.jtcvs.2021.04.087
M3 - Journal article
C2 - 34116854
AN - SCOPUS:85106424409
VL - 165
SP - 1285-1297.e6
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
SN - 0022-5223
IS - 4
ER -
ID: 273653263