Key result
Reintervention after stentless aortic valve replacement carries ~9% early mortality, improving in recent elective cases.
Why the study?
Repeat aortic valve interventions after previous stentless AVR are considered technically challenging with increased perioperative risk, especially after full-root replacement.
Observational (n=75)
No
Reinterventions after stentless AVR carry notable transcatheter risk despite improving elective outcomes; leaves open optimal strategy in this population.
OBJECTIVES: Repeat aortic valve interventions after previous stentless aortic valve replacement (AVR) are considered technically challenging with an increased perioperative risk, especially after full-root replacement. We analysed our experience with reinterventions after stentless AVR. METHODS: A total of 75 patients with previous AVR using a Freestyle stentless bioprosthesis (31 subcoronary, 15 root-inclusion and 29 full-root replacement) underwent reintervention in our centre from 1993 until December 2018. Periprocedural data were retrospectively collected from the department database and follow-up data were prospectively collected. RESULTS: Median age was 62 years (interquartile range 47-72 years). Indications for reintervention were structural valve deterioration (SVD) in 47, non-SVD in 13 and endocarditis in 15 patients. Urgent surgery was required in 24 (32%) patients. Reinterventions were surgical AVR in 16 (21%), root replacement in 51 (68%) and transcatheter AVR in 8 (11%) patients. Early mortality was 9.3% (n = 7), but decreased to zero in the past decade in 28 patients undergoing elective reoperation. Per indication, early mortality was 9% for SVD, 8% for non-SVD and 13% for endocarditis. Aortic root replacement had the lowest early mortality rate (6%), followed by surgical AVR (13%) and transcatheter AVR (25%, 2 patients with coronary artery obstruction). Pacemaker implantation rate was 7%. Overall survival rate at 10 years was 69% (95% confidence interval 53-81%). CONCLUSIONS: Repeat aortic valve interventions after stentless AVR carry an increased, but acceptable, early mortality risk. Transcatheter valve-in-valve procedures after stentless AVR require careful consideration of prosthesis leaflet position to prevent obstruction of the coronary arteries.
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Schneider et al. (2019) conducted an observational in Previous stentless aortic valve replacement requiring reintervention (n=75). Reintervention after stentless aortic valve replacement was evaluated on Early mortality (within 30 days or index admission). Reinterventions after stentless aortic valve replacement had an overall early mortality rate of 9.3%, which decreased to zero in recent elective cases, though transcatheter procedures carried a 25% mortality risk.
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