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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Stentless aortic valve reoperations: a surgical challenge
Michael A Borger1, Kriengchai Prasongsukarn, Susan Armstrong
1Division of Cardiovascular Surgery, Toronto General Hospital, and Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
The Annals of Thoracic Surgery
|August 28, 2007
Summary
Stentless aortic valve reoperations are challenging, often needing aortic root replacement. Early reoperation within one year of initial implantation significantly increases the risk of death for patients undergoing redo aortic valve replacement.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Surgery
- Bioprosthetic Valve Research
Background:
- Stentless bioprosthetic aortic valves may require reoperation due to limited durability.
- Few studies have focused on stentless aortic valve reoperations.
- This study reviews institutional outcomes for stentless valve reoperations.
Purpose of the Study:
- To evaluate the outcomes of stentless aortic valve reoperations.
- To identify risk factors associated with stentless valve reoperation.
- To assess the need for aortic root replacement during reoperation.
Main Methods:
- Retrospective review of 57 patients undergoing redo aortic valve replacement (AVR) with stentless valves.
- Analysis of prior valve types (Freestyle or Toronto stentless porcine valve).
- Examination of reoperation indications, procedures, and outcomes.
Main Results:
- Redo AVR occurred 8.4 years post-implantation; 51% were urgent.
- Structural valve dysfunction (84%) and aortic insufficiency (82%) were primary indications.
- Aortic root replacement was needed in 63% of cases, often due to adhesions.
- Operative mortality was 11%, with significantly higher risk if reoperation occurred within 1 year (67% vs. 7%).
- Five-year survival was 79%, with 81% of survivors in NYHA class I or II.
Conclusions:
- Stentless aortic valve reoperation is complex and frequently necessitates aortic root replacement.
- Reoperation carries an elevated mortality risk, especially when performed within the first year after initial implantation.
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