• Hanna H Dagnegård, Kirstine Bekke, Solveig M Kolseth, Natalie Glaser, Christoffer Wallén, Ismail El-Hamamsy, Kristjan O Vidisson, Asbjørn S Lie, Jan B Valentin, Ulrik Sartipy, Rune Haaverstad, Farkas Vanky, Laurence Lefebvre, Tomas Gudbjartsson, Søren P Johnsen, Lars Søndergaard, Gustav H Thyregod, Jens T Lund, Nikolaj Ihlemann, and Morten H Smerup.
• Department of Cardiothoracic Surgery, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark. Electronic address: hanna.dagnegaard@regionh.dk.
• J. Thorac. Cardiovasc. Surg. 2022 Dec 1; 164 (6): 17121724.e101712-1724.e10.

ObjectivesOur objective was to examine intermediate-term survival and reinterventions in unselected patients, stratified according to indication, who received a Freestyle (Medtronic Inc, Minneapolis, Minn) bioprosthesis as a full aortic root replacement.MethodsData from medical records were retrospectively collected for patients who had aortic root replacement using Freestyle bioprostheses between 1999 and 2018 at 6 North-Atlantic centers. Survival status was extracted from national registries and results stratified according to indication for surgery.ResultsWe included 1030 implantations in 1008 patients with elective indications for surgery: aneurysm (39.8%), small root (8.3%), and other (13.8%), and urgent/emergent indications: endocarditis (26.7%) and Stanford type A aortic dissection (11.4%). Across indications, 46.3% were nonelective cases and 34.0% were reoperations. Median age was 66.0 (interquartile range, 58.0-71.8) years and median follow-up was 5.0 (interquartile range, 2.6-7.9) years. Thirty-day mortality varied from 2.9% to 27.4% depending on indication. Intermediate survival for 90-day survivors with elective indications were not different from the general population standardized for age and sex (P = .95, .83, and .16 for aneurysms, small roots, and other, respectively). In contrast, patients with endocarditis and type A dissection had excess mortality (P < .001). Freedom from valve reinterventions was 95.0% and 94.4% at 5 and 8 years, respectively. In all, 52 patients (5.2%) underwent reinterventions, most because of endocarditis.ConclusionsAt intermediate term follow-up this retrospective study provides further support for the use of the Freestyle bioprosthesis in the real-world setting of diverse, complex, and often high-risk aortic root replacement and suggests that outcome is determined by patient and disease, rather than by prosthesis, characteristics.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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