title: Long Term Outcomes Following Freestyle Stentless Aortic Bioprosthesis Implantation: An Australian Experience.
abstract: BACKGROUND
  The Freestyle stentless bioprosthesis (FSB) has been demonstrated to be a durable prosthesis in the aortic position. We present data following Freestyle implantation for up to 10 years post-operatively and compare this with previously published results.
  
  
  METHODS
  A retrospective cohort analysis of 237 patients following FSB implantation occurred at five Australian hospitals. Follow-up data included clinical and echocardiographic outcomes.
  
  
  RESULTS
  The cohort was 81.4% male with age 63.2±13.0 years and was followed for a mean of 2.4±2.3 years (range 0-10.9 years, total 569 patient-years). The FSB was implanted as a full aortic root replacement in 87.8% patients. The 30-day all cause mortality was 4.2% (2.0% for elective surgery). Cumulative survival at one, five and 10 years was 91.7±1.9%, 82.8±3.8% and 56.5±10.5%, respectively. Freedom from re-intervention at one, five and 10 years was 99.5±0.5%, 91.6±3.7% and 72.3±10.5%, respectively. At latest echocardiographic review (mean 2.3±2.1 years post-operatively), 92.6% had trivial or no aortic regurgitation. Predictors of post-operative mortality included active endocarditis, acute aortic dissection and peripheral vascular disease.
  
  
  CONCLUSIONS
  We report acceptable short and long term outcomes following FSB implantation in a cohort of comparatively younger patients with thoracic aortic disease. The durability of this bioprosthesis in the younger population remains to be confirmed.
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Sherrah
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: Richmond W
authors.initials: RW
authors.lastname: Jeremy
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Puranik
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Bannon
authors.affiliation: The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: P Nicholas
authors.initials: PN
authors.lastname: Hendel
authors.affiliation: The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Bayfield
authors.affiliation: The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Wilson
authors.affiliation: Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, NSW, Australia.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Brady
authors.affiliation: Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, NSW, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Marshman
authors.affiliation: Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, NSW, Australia.
authors.forename: Manu N
authors.initials: MN
authors.lastname: Mathur
authors.affiliation: Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, NSW, Australia.
authors.forename: R John
authors.initials: RJ
authors.lastname: Brereton
authors.affiliation: Darcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: James R
authors.initials: JR
authors.lastname: Edwards
authors.affiliation: Darcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Stuklis
authors.affiliation: Darcy Sutherland Cardiothoracic Surgical Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Worthington
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, NSW, Australia; The Baird Institute for Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, NSW, Australia. Electronic address: michael.vallely@sydneyheartandlung.com.au.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Vallely
mesh_terms: D000368:Aged; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D014463:Ultrasonography
keywords: Aorta; Aortic Aneurysm; Aortic valve; Bioprosthesis; Heart valve prosthesis; Thoracic