Reinterventions after freestyle stentless aortic valve replacement: an assessment of procedural risks

Schneider, A.W.; Hazekamp, M.G.; Versteegh, M.I.M.; Weger, A. de; Holman, E.R.; Klautz, R.J.M.; ... ; Braun, J. (2019)

Article / Letter to editor

OBJECTIVES: Repeat aortic valve interventions after previous stentless aortic valve replacement (AVR) are considered technically challenging with an increased perioperative risk, especially after full-root replacement. We analysed our experience with reinterventions after stentless AVR.METHODS: A total of 75 patients with previous AVR using a Freestyle stentless bioprosthesis (31 subcoronary, 15 root-inclusion and 29 full-root replacement) underwent reintervention in our centre from 1993 until December 2018. Periprocedural data were retrospectively collected from the department database and follow-up data were prospectively collected.RESULTS: Median age was 62 years (interquartile range 47-72 years). Indications for reintervention were structural valve deterioration (SVD) in 47, non-SVD in 13 and endocarditis in 15 patients. Urgent surgery was required in 24 (32%) patients. Reinterventions were surgical AVR in 16 (21%), root replacement in 51 (68%) and transcatheter AVR in 8 (11%) patients. Early mortality was 9.3% (n = 7), but decreased to zero in the past decade in 28 patients undergoing elective reoperation. Per indication, early mortality was 9% for SVD, 8% for non-SVD and 13% for endocarditis. Aortic root replacement had the lowest early mortality rate (6%), followed by surgical AVR (13%) and transcatheter AVR (25%, 2 patients with coronary artery obstruction). Pacemaker implantation rate was 7%. Overall survival rate at 10 years was 69% (95% confidence interval 53-81%).CONCLUSIONS: Repeat aortic valve interventions after stentless AVR carry an increased, but acceptable, early mortality risk. Transcatheter valve-in-valve procedures after stentless AVR require careful consideration of prosthesis leaflet position to prevent obstruction of the coronary arteries.

• Aortic root replacement
• Aortic valve replacement
• Heart valve replacement
• Percutaneous
• Reoperation

• All authors: Schneider, A.W.; Hazekamp, M.G.; Versteegh, M.I.M.; Weger, A. de; Holman, E.R.; Klautz, R.J.M.; Bruggemans, E.F.; Braun, J.
• Date: 2019-12-01
• Journal: European Journal of Cardio-Thoracic Surgery
• Volume: 56
• Issue: 6
• Pages: 1117 - 1123
• DOI: doi:10.1093/ejcts/ezz222