title: Midterm outcome after aortic root replacement with stentless porcine bioprostheses.
abstract: OBJECTIVE
  Midterm clinical outcome was evaluated after aortic root replacement with Freestyle® stentless aortic root bioprostheses.
  
  
  METHODS
  Between April 1996 and December 2007, 301 patients underwent aortic valve replacement with stentless Medtronic Freestyle® bioprostheses in full-root technique at a single center. Concomitant coronary artery bypass grafting (CABG) was required in 96 patients (32%). In 94 patients (31%), the ascending aorta was replaced. The mean age was 71.6 ± 9.1 (range: 36-89) years. Follow-up was closed in October 2008, 99% complete and encompassed 916 patient-years.
  
  
  RESULTS
  Overall mortality within 30 days was 5%. A total of 62 patients died during the follow-up period. Overall survival at 5 and 9 years was 74 ± 4% and 53 ± 6%, respectively. Re-operations were required in three patients: in one patient due to structural valve deterioration, and in two patients due to prosthetic valve endocarditis. Non-structural dysfunctions were not observed. In eight patients, prosthetic valve endocarditis occurred, in most of them (N = 6) during the first year after surgery. Rate of freedom from re-operation, structural valve deterioration, prosthetic valve endocarditis, thrombo-embolic and major bleeding events at 9 years was 94 ± 6%, 94 ± 6%, 94 ± 3%, 87 ± 5%, and 95 ± 2%, respectively. The linearized rates of late adverse events in percent per patient-year were 0.35, 0.12, 0.83, 1.7, and 0.7, respectively, for re-operation, structural valve deterioration, prosthetic valve endocarditis, thrombo-embolic and major bleeding events. A little less than a quarter (22%) of the patients required anticoagulation therapy.
  
  
  CONCLUSIONS
  Aortic root replacement with the stentless Freestyle® bioprosthesis provided a respectable short-term mortality, optimal valve durability and acceptable rates of valve-related complications within 9 years.
authors.affiliation: Mediclin Heart Institute Lahr/Baden, Lahr, Germany.
authors.forename: Ina C
authors.initials: IC
authors.lastname: Ennker
authors.forename: Alexander
authors.initials: A
authors.lastname: Albert
authors.forename: Fatmir
authors.initials: F
authors.lastname: Dalladaku
authors.forename: Ulrich
authors.initials: U
authors.lastname: Rosendahl
authors.forename: Juergen
authors.initials: J
authors.lastname: Ennker
authors.forename: Ines
authors.initials: I
authors.lastname: Florath
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery; D001705:Bioprosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D001026:Coronary Artery Bypass; D004696:Endocarditis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012086:Reoperation; D015607:Stents; D016019:Survival Analysis; D013923:Thromboembolism / Q000209:etiology; D016896:Treatment Outcome