Long-term Outcomes Following Reoperations for Stentless Aortic Valves.

Background: : There is limited data on the long-term outcomes in patients who have undergone a reoperation following a failing stentless aortic valve. Methods: : Between 2006-2016, a retrospective analysis was performed on 24 patients that underwent open aortic valve replacement surgery for a failed stentless aortic valve prosthesis at Health Sciences North, Sudbury, Ontario, Canada. The primary outcome was low mortality from cardiac related deaths after 5 years. Results: : All patients underwent an insertion of a Medtronic Freestyle bioprosthesis implanted in the modified subcoronary technique for their initial operation. The interval from the first operation to the stentless redo surgery ranged from 6-13 years. Aortic valve reoperation was performed for structural valve deterioration in 96% (n= 23) of the cases. Reoperations involved a removal of the stented valve leaflets and stented valve-in-valve implantation in 20% (n= 5) of the cases, with the remaining cases requiring complete removal of the stentless prosthesis and aortic valve replacement. In those where a complete removal of the stentless valve was possible (n=19), there was no disruption of the native aortic root, and a 0% conversion to a Bentall procedure. There was no intraoperative mortality. The 30-day and 10-year operative mortality was 4% and 16%, respectively. Conclusions: : Redo surgery for failing stentless valves can be done with relatively low-risk and with acceptable long-term outcomes without resorting to root replacement techniques.