Abstract 3685: Late Outcomes Following Freestyle versus Homograft Aortic Root Replacement: Results From a Prospective Randomized Trial
Introduction - The ideal substitute for aortic root replacement remains undetermined. The aims of this study were to compare long-term results following Homograft versus Freestyle aortic root replacement.
Methods - Between 1997 and 2005, 166 patients (65±8 years) undergoing aortic root replacement were prospectively randomized to receive a Homograft (n=76) or a Freestyle bioprosthesis (n=90). Six patients randomized to Homograft crossed over to Freestyle due to lack of suitably-sized homografts. Median follow-up was 7.6 years (maximum 11 years; 1035 patient-years). “Evolving” aortic valve (AV) dysfunction was defined as aortic regurgitation ≥2/4 and/or peak gradient >20mmHg.
Results - Patient characteristics and operative data were comparable between groups. Overall hospital mortality was 4.8% (1% for isolated root replacement). Eight-year survival was 80±5% in the Freestyle group versus 77±6% in the Homograft group (p=0.9). Freedom from reoperation at 8 years was significantly higher after Freestyle root replacement (100±0% versus 90±5% after Homograft replacement; p=0.02). All reoperations were due to structural valve deterioration (n=6). Actuarial freedom from “evolving” AV dysfunction was 85±5% for Freestyle versus 37±7% for Homografts at 8 years (p<0.001). Clinically, freedom from NYHA III-IV and valve-related complications were similar between groups (p=0.7 and 0.9, respectively).
Conclusion - In conclusion, survival is similar following Homograft versus Freestyle root replacement. However, Freestyle aortic root replacement is associated with significantly less progressive aortic valve dysfunction and a lower need for reoperations.