P023. A Single-Center Experience of Aortic Root Replacement with the Freestyle Prosthesis
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Gainesville, FL
United States - Contact Me
My name is Iverson Williams and I am currently a third-year medical student at the University of Florida College of Medicine. I currently hold a Bachelor of Science degree in Applied Physiology and Kinesiology from the University of Florida. My future interests are to pursue a career in cardiothoracic surgery.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: Aortic root replacement with a stentless valve has become an effective treatment for patients with aortic root pathology, including dissection, aneurysm, and endocarditis of the aortic valve, allowing for a greater effective orifice area for the implanted valve and increased hemodynamic stability compared to conventional stented aortic valves. However, candidates for aortic root replacements tend to be severely comorbid populations that are at high risk of mortality. The purpose of this study is to evaluate the outcomes of patients who underwent aortic root replacement with the Medtronic Freestyle prosthesis (Medtronic, Minneapolis, MN, USA).
Methods: We performed a single-center retrospective review of adult patients (≥18 years) who underwent aortic root replacement with a Medtronic Freestyle prosthesis from July 1, 2014, to May 15, 2023. Descriptive statistics were performed. Continuous variables are reported as mean ± standard deviation or median (interquartile range [IQR]), and categorical variables are reported as frequency and percentage. The Kaplan-Meier method was used to estimate longitudinal survival.
Results: During the study period, 127 patients underwent a Freestyle aortic root replacement. Most patients were male (61.4%, n=78), and mean age was 60.1±15.2 years. Many patients had at least one prior sternotomy (80.3%, n=102). Other comorbidities included hypertension in 74.8% (n=95), diabetes in 33.9% (n=43), preoperative acute kidney injury in 8.7% (n=11), chronic kidney disease in 18.9% (n=24), and history of stroke in 26.0% (n=33). The majority of patients were indicated for aortic root replacement due to endocarditis (47.2%, n=60). Mean valve size implanted was 26.0±2.2 mm. Cardiopulmonary bypass time was 312.5±103.4 minutes, and cross-clamp time was 220.5±70.7 minutes. Postoperatively, 6.3% (n=8) required permanent dialysis, 9.5% (n=12) had pneumonia, 5.5% (n=7) had a stroke, and 37.0% (n=47) required a new permanent pacemaker. Ten (7.9%) patients died before hospital discharge. During follow-up, 3 (2.4%) patients developed root pseudoaneurysms. Follow-up echocardiography was available in 54 (42.5%) patients at a median follow-up time of 213 (IQR 49.3-525) days. Peak gradient was 21.8±9.8 mmHg, and mean gradient was 9.5±4.5 mmHg. Longitudinal survival is shown in Figure 1.
Conclusions: Among high-risk patients undergoing aortic root replacement at a single center, the Freestyle prosthesis is associated with limited rates of postoperative morbidity.
Authors
Iverson Williams (1), Omar Sharaf (2), Zaid Abu-Mowis (3), William Ricks (4), Eric Jeng (5), John Spratt (6), Tomas Martin (7), Thomas Beaver (8)
Institutions
(1) N/A, N/A, (2) N/A, Berlin, CT, (3) University of Florida College of Medicine, Gainesville, FL, (4) The University of Florida, N/A, (5) University of Florida- Shands, Gainesville, FL, (6) University of Florida, Gainesville, FL, (7) Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, (8) Shands, Gainesville, FL
Methods: We performed a single-center retrospective review of adult patients (≥18 years) who underwent aortic root replacement with a Medtronic Freestyle prosthesis from July 1, 2014, to May 15, 2023. Descriptive statistics were performed. Continuous variables are reported as mean ± standard deviation or median (interquartile range [IQR]), and categorical variables are reported as frequency and percentage. The Kaplan-Meier method was used to estimate longitudinal survival.
Results: During the study period, 127 patients underwent a Freestyle aortic root replacement. Most patients were male (61.4%, n=78), and mean age was 60.1±15.2 years. Many patients had at least one prior sternotomy (80.3%, n=102). Other comorbidities included hypertension in 74.8% (n=95), diabetes in 33.9% (n=43), preoperative acute kidney injury in 8.7% (n=11), chronic kidney disease in 18.9% (n=24), and history of stroke in 26.0% (n=33). The majority of patients were indicated for aortic root replacement due to endocarditis (47.2%, n=60). Mean valve size implanted was 26.0±2.2 mm. Cardiopulmonary bypass time was 312.5±103.4 minutes, and cross-clamp time was 220.5±70.7 minutes. Postoperatively, 6.3% (n=8) required permanent dialysis, 9.5% (n=12) had pneumonia, 5.5% (n=7) had a stroke, and 37.0% (n=47) required a new permanent pacemaker. Ten (7.9%) patients died before hospital discharge. During follow-up, 3 (2.4%) patients developed root pseudoaneurysms. Follow-up echocardiography was available in 54 (42.5%) patients at a median follow-up time of 213 (IQR 49.3-525) days. Peak gradient was 21.8±9.8 mmHg, and mean gradient was 9.5±4.5 mmHg. Longitudinal survival is shown in Figure 1.
Conclusions: Among high-risk patients undergoing aortic root replacement at a single center, the Freestyle prosthesis is associated with limited rates of postoperative morbidity.
Authors
Iverson Williams (1), Omar Sharaf (2), Zaid Abu-Mowis (3), William Ricks (4), Eric Jeng (5), John Spratt (6), Tomas Martin (7), Thomas Beaver (8)
Institutions
(1) N/A, N/A, (2) N/A, Berlin, CT, (3) University of Florida College of Medicine, Gainesville, FL, (4) The University of Florida, N/A, (5) University of Florida- Shands, Gainesville, FL, (6) University of Florida, Gainesville, FL, (7) Division of Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, (8) Shands, Gainesville, FL
Presentation Duration
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