Freestyle Prosthesis for Aortic Root-replacement With and Without Hemiarch Replacement

Triemli Hospital

Status: Completed

Conditions: Valve Heart Disease; Endocarditis; Root Abscess; Aortic Aneurysm; Aortic Dissection

Treatments: Procedure: Aortic root replacement with Freestyle biological prosthesis with and without hemiarch replacement

Study type: Observational

Funder types: Other

Identifiers

NCT04068337

BASEC-Nr. 2018-01227

Details and patient eligibility

About

The Freestyle® prosthesis (Medtronic plc, Dublin, Ireland) is a biological, porcine aortic root implanted in various combinations and techniques since the 1990s. The main indication for the choice of this prosthesis is a combined pathology with degenerated aortic valve and additional dilatation of the root often involving the ascending aorta.

The Freestyle® prosthesis is also used in cases of dissection of the ascending aorta with the involvement of the aortic valve, which opens the debate on how far the ascending aorta should be replaced for a sustainable solution with calculable low periprocedural risk. Considering a lower intraoperative risk in the life-threatening situation, an extended resection of the aorta can be avoided and only the aortic root replaced with a piece of ascending aorta. On the contrary, focusing on improved long-term outcome, the technique of total arch replacement in aortic dissection was developed in emergency situations with acceptable results, which, however, were often reproducible only in large, experienced centers.

Apart from the abovementioned options, the technique of proximal arch replacement can provide a tension-free anastomosis. The intention of hemiarch replacement is the attachment of the prosthesis to an aneurysm-free portion of the aortic arch helping to protect against further anastomotic aneurysms and spare the patient complex reoperation or interventional procedures in the future. As a possible drawback of the technique, especially in emergency situations, the potentially prolonged duration of surgery and the need of selective brain perfusion via axillary or carotid artery are discussed increasing the risk of stroke and further major events, which could not be reflected in current literature. However, there is still no convincing evidence of a long-term benefit in terms of re-operation and survival after hemiarch replacement.

The aim of this retrospective analysis was to assess the mid-term outcome of the biological Freestyle® prosthesis in combination with operations on the ascending aorta and the aortic arch with regard to prosthetic performance, reoperations, stroke and death.

Enrollment: 278 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• all patients after implantation of a biological Medtronic Freestyle root prosthesis in the time frame from November 2007 till April 2017
• elective, urgent and emergency operations on ascending aneurysms, aortic dissections, endocarditis and aortic root pathologies
• combination of other procedures (coronary artery bypass grafting, operations on mitral and tricuspid valve, ablations)

Exclusion criteria

• refused patient consent

Trial design

278 participants in 2 patient groups

Hemiarch

Description:

Patients with Freestyle aortic root implantation receiving a hemiarch replacement by open anastomosis technique with axillary cannulation and antegrade cerebral perfusion

Treatment:

Procedure: Aortic root replacement with Freestyle biological prosthesis with and without hemiarch replacement

Non-Hemiarch

Description:

Patients with Freestyle aortic root implantation without hemiarch replacement with normal systemic perfusion

Treatment:

Procedure: Aortic root replacement with Freestyle biological prosthesis with and without hemiarch replacement