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Thorac Cardiovasc Surg 2019; 67(08): 644-651
DOI: 10.1055/s-0038-1668134
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Is the Freedom SOLO Stentless Bioprosthesis a Useful Tool for Patients with Aortic Endocarditis and Aortic Annular Destruction?

Alberto Repossini
1   Department of Cardiac Surgery, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
,
Lorenzo Di Bacco
1   Department of Cardiac Surgery, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
,
Laszlo Gazdag
2   Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
,
Herko Grubitzsch
3   Department of Cardiac Surgery, Charité, Campus Mitte, Germany
,
Theodor Fischlein
2   Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
,
Alessandra Stara
1   Department of Cardiac Surgery, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
,
Claudio Muneretto
1   Department of Cardiac Surgery, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
,
Giuseppe Santarpino
2   Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
› Author Affiliations
Further Information

Publication History

04 December 2017

02 July 2018

Publication Date:
16 August 2018 (online)

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Abstract

Background The Freedom SOLO (FS) stentless bovine-pericardial prosthesis with a supra-annular implantation technique can be a viable option for patients with endocarditic annular destruction. We assessed early- and long-term outcomes following the use of this prosthesis in extensive aortic valve endocarditis.

Methods From 2006 to 2016, 59 patients with extensive aortic endocarditis underwent aortic valve replacement (AVR) with FS (cumulative follow-up 263 patients-years) in three European centers; all patients presented annular tissue infection, while 54.3% of patients had annular abscess.

Results Mean age was 66 ± 11 years and mean EuroSCORE I was 30.3% (standard deviation: 24.1%). In our series, 30.5% of patients had prosthetic valve endocarditis. Early mortality was 15.2% (nine patients). Estimated overall survival at 5 and 10 years was 68.9% (95% confidence interval [CI]: 62.8–75.0%) and 59.1% (95% CI: 66.8–81.2%), respectively. At 10-year survival, freedom from valve-related death was 83.7% (95% CI: 80.9–86.5%). No structural valve deterioration was reported in this series. Five patients (8.5%) had recurrent endocarditis during follow-up and two of them underwent reoperation. Survival freedom from reoperation and endocarditis at 10-year follow-up was 88.0% (CI: 80.4–95.6%) and 86.7% (CI: 80.5–92.9%), respectively.

Conclusion FS stentless bioprosthesis is a valuable and simple option to achieve AVR in patients with extensive aortic annulus endocarditis. Although in this group of complex patients, early mortality remains considerably high, late survival outcomes are comparable to the more technically demanding homografts and conventional stentless bioprostheses, with low rates of endocarditis recurrence.

Keywords

stentless bioprostheses - aortic valve endocarditis - aortic annulus abscess
 

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