Long-term Outcomes Following Reoperations for Stentless Aortic Valves.
Abstract
Background: There is limited data on the long-term outcomes in
patients who have undergone a reoperation following a failing stentless
aortic valve. Methods: Between 2006-2016, a retrospective
analysis was performed on 24 patients that underwent open aortic valve
replacement surgery for a failed stentless aortic valve prosthesis at
Health Sciences North, Sudbury, Ontario, Canada. The primary outcome was
low mortality from cardiac related deaths after 5 years.
Results: All patients underwent an insertion of a Medtronic
Freestyle bioprosthesis implanted in the modified subcoronary technique
for their initial operation. The interval from the first operation to
the stentless redo surgery ranged from 6-13 years. Aortic valve
reoperation was performed for structural valve deterioration in 96% (n=
23) of the cases. Reoperations involved a removal of the stented valve
leaflets and stented valve-in-valve implantation in 20% (n= 5) of the
cases, with the remaining cases requiring complete removal of the
stentless prosthesis and aortic valve replacement. In those where a
complete removal of the stentless valve was possible (n=19), there was
no disruption of the native aortic root, and a 0% conversion to a
Bentall procedure. There was no intraoperative mortality. The 30-day and
10-year operative mortality was 4% and 16%, respectively.
Conclusions: Redo surgery for failing stentless valves can be
done with relatively low-risk and with acceptable long-term outcomes
without resorting to root replacement techniques.