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. 2021 Jul 28;16(1):204.
doi: 10.1186/s13019-021-01583-y.

Geometric changes in aortic root replacement using Freestyle prosthesis

Anja Osswald  1 , Alina Zubarevich  2 , Arian Arjomandi Rad  3 , Robert Vardanyan  3 , Konstantin Zhigalov  2 , Daniel Wendt  2 , Bastian Schmack  2 , Ahmed Mashhour  2   4 , Arjang Ruhparwar  2 , Alexander Weymann  2
Affiliations

Geometric changes in aortic root replacement using Freestyle prosthesis

Anja Osswald et al. J Cardiothorac Surg. .

Abstract

Background: The Medtronic Freestyle prosthesis has proven to be a promising recourse for aortic root replacement in various indications. The present study aims to evaluate clinical outcomes and geometric changes of the aorta after Freestyle implantation.

Methods: Between October 2005 and November 2020, the computed tomography angiography (CTA) data of 32 patients were analyzed in a cohort of 68 patients that underwent aortic root replacement using Freestyle prosthesis. The minimum and maximum diameters and areas of the aortic annulus, aortic root, ascending aorta, and the proximal aortic arch were measured at a plane perpendicular to the long axis of the aorta using 3D multiplanar reconstruction in both the preoperative (n = 32) and postoperative (n = 10) CTAs. Moreover, volumetric changes of the aortic root and ascending aorta were quantified.

Results: Mean age was 64.6 ± 10.6 years. Indications for surgery using Freestyle prosthesis were combined aortic valve pathologies, aortic aneurysm or dissection, and endocarditis, with concomitant surgery occurring in 28 out of 32 patients. In-hospital mortality was 18.6%. Preoperative diameter and area measurements of the aortic annulus strongly correlated with the implanted valve size (p < 0.001). Bicuspid valve was present in 28.1% of the patients. Diameter and areas of the aortic root decreased after freestyle implantation, resulting in a reduction of the aortic root volume (45.6 ± 26.3 cm3 to 18.7 ± 4.5 cm3, p = 0.029). Volume of the aortic root and the ascending aorta decreased from 137.3 ± 65.2 cm3 to 54.5 ± 21.1 cm3 after Freestyle implantation (p = 0.023).

Conclusion: Implantation of the Freestyle prosthesis presents excellent results in restoring the aortic geometry. Preoperative CTA measurements are beneficial to the surgical procedure and valve selection and therefore, if available, should be considered in pre-operative planning.

Keywords: Aortic root; Aortic valve replacement; Bioroot; Computed tomography measurement.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient inclusion
Fig. 2
Fig. 2
3-dimensional computed tomography reconstruction, with the visualization of the aortic root on a plane perpendicular to the long axis of the aorta (A-C)
Fig. 3
Fig. 3
The maximum and minimum diameter and areas of the aortic annulus (A), sinus valsalva (B), sinotubular junction (C), ascending aorta (D) and the proximal aortic arch (E) were measured using 3D multiplanar reconstruction
Fig. 4
Fig. 4
Preoperative measurements of the aortic root were performed sinus-to-sinus (A) and sinus-to-commissures (B)
Fig. 5
Fig. 5
Volumetric measurements were performed on pre- (A) and postoperative (C) CTAs, with the areas of interest drawn manually in each slice (B, D). These measurements demonstrate a decrease of the ascending aorta after Freestyle implantation
See this image and copyright information in PMC

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