Long-term survival rates for matched groups of composite valve graft and stentless aortic root replacement over time
Survival rates
1 year
5 years
10 years
15 years
17 years
20 years
Composite valve graft
87% (81.3–90.8)
80% (73.2–85.5)
74% (65.4–81.3)
65% (48.9–77.4)
47% (21.7–68.8)
47% (21.7–68.8)
Stentless aortic root
91% (86.6–94.4)
87% (81.6–91.0)
82% (74.9–87.2)
71% (56.3–82.2)
71% (56.3–82.2)
54% (19.9–78.6)
Declarations
Acknowledgments
The authors acknowledge the support of Siobhan Daley and Andy Ryan from Department of Quality & Safety, Harefield Hospital. Abstract presented at the EACTS 38th Annual Meeting, Lisbon, Portugal, 9–12 October 2024.
Author contributions
MC: Conceptualization, Formal analysis, Writing—original draft. MYS: Investigation. FDR, TB, SKB, and JAG: Writing—review & editing. SGR: Conceptualization, Data curation, Writing—original draft, Writing—review & editing. All authors read and approved the submitted version.
Conflicts of interest
The authors declare that there are no conflicts of interest.
Ethical approval
The study was approved by the Harefield Hospital ethics committee (Q&S 15/02/2024) and complies with the Declaration of Helsinki.
Consent to participate
Informed consent to participate in the study was waived by the Harefield Hospital ethics committee due to the retrospective nature of the study.
Consent to publication
Not applicable.
Availability of data and materials
The datasets generated and/or analyzed during the current study are not publicly available due to General Data Protection Regulation (GDPR) but are available from the senior author on reasonable request (SGR, Email: drrajashahzad@hotmail.com).
Open Exploration maintains a neutral stance on jurisdictional claims in published institutional affiliations and maps. All opinions expressed in this article are the personal views of the author(s) and do not represent the stance of the editorial team or the publisher.
References
Sá MP, Tasoudis P, Jacquemyn X, Van den Eynde J, Caranasos TG, Ikonomidis JS, et al. Long-Term Outcomes of Patients Undergoing Aortic Root Replacement With Mechanical Versus Bioprosthetic Valves: Meta-Analysis of Reconstructed Time-to-Event Data.J Am Heart Assoc. 2023;12:e030629. [DOI] [PubMed] [PMC]
Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP 3rd, Gentile F, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation. 2021;143:e72–227.Erratum in: Circulation. 2021;143:e229. Erratum in: Circulation. 2023;148:e8. Erratum in: Circulation. 2023;148:e185. Erratum in: Circulation. 2024;150:e267. [PubMed]
Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al.; ESC/EACTS Scientific Document Group. 2021 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS).Eur Heart J. 2022;43:561–632.Erratum in: Eur Heart J. 2022;43:2022. [DOI] [PubMed]
Melina G, Robertis FD, Gaer JAR, Amrani M, Khaghani A, Yacoub MH. Mid-term pattern of survival, hemodynamic performance and rate of complications after medtronic freestyle versus homograft full aortic root replacement: results from a prospective randomized trial.J Heart Valve Dis. 2004;13:972–6. [PubMed]
Nötzold A, Gerriets T, Eggers J, Kupiske G, Seidel G, Kaps M, et al. Circulating microemboli after composite replacement or valve-sparing aortic root surgery.Thorac Cardiovasc Surg. 2002;50:141–4. [DOI] [PubMed]
Enayati M, Eilenberg M, Grasl C, Riedl P, Kaun C, Messner B, et al. Biocompatibility Assessment of a New Biodegradable Vascular Graft via In Vitro Co-culture Approaches and In Vivo Model.Ann Biomed Eng. 2016;44:3319–34. [DOI] [PubMed] [PMC]
Arsalan M, Walther T. Durability of prostheses for transcatheter aortic valve implantation.Nat Rev Cardiol. 2016;13:360–7. [DOI] [PubMed]
Goldstone AB, Chiu P, Baiocchi M, Lingala B, Patrick WL, Fischbein MP, et al. Mechanical or Biologic Prostheses for Aortic-Valve and Mitral-Valve Replacement.N Engl J Med. 2017;377:1847–57. [DOI] [PubMed] [PMC]
Mookhoek A, Korteland NM, Arabkhani B, Centa ID, Lansac E, Bekkers JA, et al. Bentall Procedure: A Systematic Review and Meta-Analysis.Ann Thorac Surg. 2016;101:1684–9. [DOI] [PubMed]
Dunning J, Gao H, Chambers J, Moat N, Murphy G, Pagano D, et al. Aortic valve surgery: marked increases in volume and significant decreases in mechanical valve use—an analysis of 41,227 patients over 5 years from the Society for Cardiothoracic Surgery in Great Britain and Ireland National database.J Thorac Cardiovasc Surg. 2011;142:776–82.e3. [DOI] [PubMed]
Chen C, Chen C, Chang F, Cheng Y, Wu VC, Lin C, et al. Mechanical Versus Bioprosthetic Aortic Valve Replacement in Patients Undergoing Bentall Procedure.J Am Heart Assoc. 2024;13:e030328. [DOI] [PubMed] [PMC]
Melina G, Robertis FD, Gaer JA, Angeloni E, El-Hamamsy I, Bahrami T, et al. Long-term survival after xenograft versus homograft aortic root replacement: Results from a prospective randomized trial.J Thorac Cardiovasc Surg. 2021;161:57–65. [DOI] [PubMed]
Ennker J, Albert A, Ennker IC. Stentless aortic valves. Current aspects.HSR Proc Intensive Care Cardiovasc Anesth. 2012;4:77–82. [PubMed] [PMC]
Svensson LG, Pillai ST, Rajeswaran J, Desai MY, Griffin B, Grimm R, et al. Long-term survival, valve durability, and reoperation for 4 aortic root procedures combined with ascending aorta replacement.J Thorac Cardiovasc Surg. 2016;151:764–74.e4. [DOI] [PubMed] [PMC]
Lund O, Chandrasekaran V, Grocott-Mason R, Elwidaa H, Mazhar R, Khaghani A, et al. Primary aortic valve replacement with allografts over twenty-five years: valve-related and procedure-related determinants of outcome.J Thorac Cardiovasc Surg. 1999;117:77–91. [DOI] [PubMed]
Arabkhani B, Bekkers JA, Andrinopoulou E, Roos-Hesselink JW, Takkenberg JJM, Bogers AJJC. Allografts in aortic position: Insights from a 27-year, single-center prospective study.J Thorac Cardiovasc Surg. 2016;152:1572–9.e3. [DOI] [PubMed]
Bekkers JA, Klieverik LMA, Raap GB, Takkenberg JJM, Bogers AJJC. Re-operations for aortic allograft root failure: experience from a 21-year single-center prospective follow-up study.Eur J Cardiothorac Surg. 2011;40:35–42. [DOI] [PubMed]
Peterss S, Fabry TG, Steffen J, Orban M, Buech J, Radner C, et al. Aortic valved homograft degeneration: surgical or transcatheter approach for repeat aortic valve replacement?Eur J Cardiothorac Surg. 2024;66:ezae280. [DOI] [PubMed]
Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al.; ESC Scientific Document Group. 2017 ESC/EACTS Guidelines for the management of valvular heart disease.Eur Heart J. 2017;38:2739-91. [DOI] [PubMed]
Dumesnil JG, LeBlanc MH, Cartier PC, Métras J, Desaulniers D, Doyle DP, et al. Hemodynamic features of the freestyle aortic bioprosthesis compared with stented bioprosthesis.Ann Thorac Surg. 1998;66:S130–3. [DOI] [PubMed]
Pibarot P, Dumesnil JG, Jobin J, Cartier P, Honos G, Durand LG. Hemodynamic and physical performance during maximal exercise in patients with an aortic bioprosthetic valve: Comparison of stentless versus stented bioprostheses.J Am Coll Cardiol. 1999;34:1609–17. [DOI] [PubMed]
Fries R, Wendler O, Schieffer H, Schäfers HJ. Comparative rest and exercise hemodynamics of 23-mm stentless versus 23-mm stented aortic bioprostheses.Ann Thorac Surg. 2000;69:817–22. [DOI] [PubMed]
Bach DS, Kon ND, Dumesnil JG, Sintek CF, Doty DB. Ten-year outcome after aortic valve replacement with the freestyle stentless bioprosthesis.Ann Thorac Surg. 2005;80:480–7. [DOI] [PubMed]
Bach DS, Metras J, Doty JR, Yun KL, Dumesnil JG, Kon ND. Freedom from structural valve deterioration among patients aged < or = 60 years undergoing Freestyle stentless aortic valve replacement.J Heart Valve Dis. 2007;16:649–56. [PubMed]
Mohammadi S, Tchana-Sato V, Kalavrouziotis D, Voisine P, Doyle D, Baillot R, et al. Long-term clinical and echocardiographic follow-up of the Freestyle stentless aortic bioprosthesis.Circulation. 2012;126:S198–204. [DOI] [PubMed]
Bach DS, Kon ND. Long-term clinical outcomes 15 years after aortic valve replacement with the Freestyle stentless aortic bioprosthesis.Ann Thorac Surg. 2014;97:544–51. [DOI] [PubMed]
Tavakoli R, Danial P, Oudjana AH, Jamshidi P, Gassmann M, Leprince P, et al. Biological aortic valve replacement: advantages and optimal indications of stentless compared to stented valve substitutes. A review.Gen Thorac Cardiovasc Surg. 2018;66:247–56. [DOI] [PubMed]
