Abstract 16922: Accelerated Degeneration and Late Detachment of the Freestyle Aortic Root in Young Adults

Abstract

Introduction: The ideal valve substitute for the aortic valve in young adults is yet to be identified. The Freestyle stentless aortic root seems to be a viable candidate, but there is not enough data about how it behaves in young patients. Methods: This study reports the mid-term clinical outcome after total aortic root replacement with stentless porcine root (Medtronic Freestyle) for patients younger than 50 years, in a single center, during the period from 2009 to 2017. Results: 173 patients were enrolled to this study. The median age at operation was 32 years (6-50). 56% were males. 89 patients (51%) had rheumatic heart disease, while 25 patients (14%) had bicuspid aortic valve. 10 patients (6%) had aortic aneurysm. The median valve size was 25 (21-29). 43 patients (25%) had a concomitant procedure during operation, mostly mitral valve surgery. The median bypass time was 180 minutes (82-380). The median follow-up period was 41 months (2-101). In-hospital mortality was 1.2%, while late mortality was 4%. Valve degeneration included virtual disappearance of the walls of the sinuses (encountered in 2 patients after 9 months and 3 years) and late detachment of the valve ring (in 2 patients after 2 and 5 years), resulting in false aneurysms (Figure 1a). Alarmingly, 2 of the patients who developed false aneurysms were discovered by MSCT during routine follow-up, one of them had a normal MSCT 3 years earlier, 2 years after the operation (Figure 1b). 3 patients had re-operation for false aneurysm, with no early mortality. One patient presented in cardiogenic shock caused by severe stenosis due to calcification (Figure 1c) and died after re-operation. Structural valve deterioration (defined as mean aortic gradient > 20 mmHg or aortic regurgitation > 2/4) was 21 ± 8% at 5 years. Freedom from aortic reintervention is 98 ± 3% at 5 years. Conclusions: Although the Freestyle aortic root offers excellent hemodynamics, the risk of early degeneration and the development of false aneurysms were found to be major concerns. Freestyle implantation in young patients should be used with caution. We recommend annual screening of those patients with contrast-enhanced imaging for early detection of such complications.