title: Ten-year experience with stentless aortic valves: full-root versus subcoronary implantation.
abstract: 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.
authors.affiliation: Department of Cardiothoracic Surgery, Heart Institute Lahr/Baden, Lahr, Germany.
authors.forename: Juergen A C
authors.initials: JA
authors.lastname: Ennker
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Albert
authors.forename: Ulrich P
authors.initials: UP
authors.lastname: Rosendahl
authors.forename: Ina C
authors.initials: IC
authors.lastname: Ennker
authors.forename: Fatmir
authors.initials: F
authors.lastname: Dalladaku
authors.forename: Ines
authors.initials: I
authors.lastname: Florath
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D001705:Bioprosthesis; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D011336:Probability; D011475:Prosthesis Failure; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome