Late outcomes following freestyle versus homograft aortic root replacement: results from a prospective randomized trial.
OBJECTIVE
The aims of this study were to compare long-term results after homograft versus Freestyle (Medtronic Inc., Minneapolis, Minnesota) aortic root replacement.


BACKGROUND
The ideal substitute for aortic root replacement remains undetermined.


METHODS
Between 1997 and 2005, 166 patients (age 65 +/- 8 years) undergoing total aortic root replacement were randomized to receive a homograft (n = 76) or a Freestyle bioprosthesis (n = 90). Six patients randomly assigned to homograft crossed over to Freestyle because of unavailability of suitably sized homografts. Median follow-up was 7.6 years (maximum 11 years; 1,035 patient-years). "Evolving" aortic valve dysfunction was defined as aortic regurgitation >/=2/4 and/or peak gradient >20 mm Hg.


RESULTS
Patient characteristics were comparable between groups. Concomitant procedures were performed in 44% and 47% of Freestyle and homograft patients, respectively (p = 0.5). Overall hospital mortality was 4.8% (1% for isolated root replacement). Eight-year survival was 80 +/- 5% in the Freestyle group versus 77 +/- 6% in the homograft group (p = 0.9). Freedom from need for reoperation at 8 years was significantly higher after Freestyle root replacement (100 +/- 0% vs. 90 +/- 5% after homograft replacement; p = 0.02). All reoperations were secondary to structural valve deterioration (n = 6). At last echocardiographic follow-up, actuarial freedom from evolving aortic valve dysfunction was 86 +/- 5% for Freestyle bioprostheses versus 37 +/- 7% for homografts (p < 0.001). Clinically, freedom from New York Heart Association functional class III to IV and freedom from valve-related complications were similar between groups (p = 0.7 and p = 0.9, respectively).


CONCLUSIONS
In this patient group, late survival is similar after homograft versus Freestyle root replacement. However, Freestyle aortic root replacement is associated with significantly less progressive aortic valve dysfunction and a lower need for reoperations.
El-Hamamsy
Ismail
I
Department of Cardiac Surgery, Harefield and Royal Brompton NHS Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom.
Clark
Lucy
L
Stevens
Louis M
LM
Sarang
Zubair
Z
Melina
Giovanni
G
Takkenberg
Johanna J M
JJ
Yacoub
Magdi H
MH
D000368:Aged; D001021:Aortic Valve / Q000502:physiology / Q000601:surgery* / Q000637:transplantation; D001705:Bioprosthesis; D004452:Echocardiography; D005260:Female; D006349:Heart Valve Diseases / Q000209:etiology / Q000601:surgery; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011446:Prospective Studies; D012086:Reoperation; D014184:Transplantation, Homologous; D016896:Treatment Outcome