Risk Predictors for Long-Term Outcomes in Patients Undergoing REDO Isolated Aortic Valve Replacement with Sutureless Versus Sutured Bioprosthesis

Dokollari A, Sicouri S, Kjelstrom S, Cameli M, Ghorpade N, Spooner A, Hassanabad AF, Veshti A, Prifti E, Bonacchi M and Gelsomino S

Department of Cardiac Surgery, Carim School for Cardiovascular Diseases, Maastricht University, Netherlands St. Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada Lankenau Institute for Medical Research, Wynnewood, PA, USA Department of Cardiology, University of Siena, Italy Libin Cardiovascular Institute, University of Calgary, Canada Department of Cardiac Surgery, University of Tirana, Albania Department of Clinical and Experimental Sciences, University of Florence, Italy

^*Correspondance to: Aleksander Dokollari 

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Abstract:

Objective: Long-term clinical outcomes in patients undergoing redo aortic valve replacement with sutured (SAVR) and sutureless aortic bioprosthesis remain hindered. We sought to evaluate risk predictors that influence survival after redo-SAVR versus redo-sutureless Aortic Valve Replacement (AVR). Methods: All consecutive 82 patients undergoing isolated redo-AVR with either SAVR or sutureless bioprosthesis between 08/2010-03/2020 at our institution were included. Patients with concomitant procedures were excluded from the analysis. Primary outcome was analyses of long-term all- cause mortality. A propensity-adjusted analysis was used to compare groups. Kaplan-Meier were constructed to evaluate long-term survival. Results: Preoperatively, redo-SAVR (n=57) and redo-sutureless (n=25) patients baseline characteristics were compared. Mean age was 67.2 vs. 68.5-year-old and mean Euroscore II 11% vs. 7.5%, in redo-SAVR vs. redo-sutureless, respectively. Intraoperatively, redo-SAVR experienced a higher cardiopulmonary (p=0.23) and aortic cross-clamp time (p=0.002) compared to redo- sutureless group. Postoperatively, only new incidence of Atrial Fibrillation (POAF) was higher in redo-SAVR group. Primary outcome of all-cause death at 5-years follow-up was redo-SAVR 7/57 (12.2%) vs. redo-sutureless 2/25 (8%), p=0.82; (HR 1.3 [0.2, 7.5]). New risk predictors for mortality in patients undergoing redo-SAVR included body mass index ≥ 30 kg/m2 HR (1.21 [1.04, 1.5]), and tobacco use HR (11.1 [1.1, 112.3]). Conclusion: Patients undergoing redo-SAVR experienced a higher incidence of POAF compared to patients undergoing redo sutureless valves. There were no differences on long-term all-cause death among groups.

Keywords:

Sutureless; Aortic valve replacement; Reoperation; Sutured bioprosthesis; Long- term outcomes

Cite the Article:

Dokollari A, Sicouri S, Kjelstrom S, Cameli M, Ghorpade N, Spooner A, et al. Risk Predictors for Long-Term Outcomes in Patients Undergoing REDO Isolated Aortic Valve Replacement with Sutureless Versus Sutured Bioprosthesis. World J Surg Surgical Res. 2023; 6: 1513..