Right ventricular outflow tract reconstruction with Medtronic Freestyle valve in the Ross procedure: A systematic review with meta‐analysis

Eynde, Jef Van den; Callahan, Connor P.; Dimagli, Arnaldo; Vervoort, Dominique; Kampaktsis, Polydoros; Zhigalov, Konstantin; Ruhparwar, Arjang; Weymann, Alexander

doi:10.1111/aor.13837

Cited by 4 publications

(2 citation statements)

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“…Following AVR, a high residual transvalvular gradient constitutes a risk factor for worse outcomes, impaired left ventricular diastolic dysfunction, and incomplete regression of left ventricular hypertrophy (16,17). The Freestyle aortic bioprosthesis was designed to provide superior hemodynamic performance, more physiological ow patterns, and lower transvalvular gradients (18,19). Indeed, a reduction of the mean transvalvular gradient has been described by multiple studies (20).…”

Section: Discussionmentioning

confidence: 99%

Geometric Changes in Aortic Root Replacement Using Freestyle Prosthesis

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Vardanyan

et al. 2021

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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. Pre-operative CTA measurements are beneficial to the surgical procedure and valve selection and therefore, if available, should be considered in pre-operative planning.

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Section: Discussionmentioning

confidence: 99%

Geometric Changes in Aortic Root Replacement Using Freestyle Prosthesis

Oßwald

Rad

Vardanyan

et al. 2021

Preprint

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“…Despite the diffused application, the autologous pericardium has shown a tendency to degenerate due to endothelial stress caused by blood flow through the artery [87]. Another example of the use of autografts in the treatment of paediatric CHD is the Ross procedure, which involves transplanting the native pulmonary valve into the aortic position, therefore using a pulmonary autograft to replace the defective aortic valve [88][89][90][91][92][93]. The Ross aortic valve replacement strategy enables the growth of the valve implanted in the aortic position and is therefore favourable for paediatric aortic valve replacement.…”

Section: Homografts For Chdmentioning

confidence: 99%

Biological Scaffolds for Congenital Heart Disease

et al. 2023

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Congenital heart disease (CHD) is the most predominant birth defect and can require several invasive surgeries throughout childhood. The absence of materials with growth and remodelling potential is a limitation of currently used prosthetics in cardiovascular surgery, as well as their susceptibility to calcification. The field of tissue engineering has emerged as a regenerative medicine approach aiming to develop durable scaffolds possessing the ability to grow and remodel upon implantation into the defective hearts of babies and children with CHD. Though tissue engineering has produced several synthetic scaffolds, most of them failed to be successfully translated in this life-endangering clinical scenario, and currently, biological scaffolds are the most extensively used. This review aims to thoroughly summarise the existing biological scaffolds for the treatment of paediatric CHD, categorised as homografts and xenografts, and present the preclinical and clinical studies. Fixation as well as techniques of decellularisation will be reported, highlighting the importance of these approaches for the successful implantation of biological scaffolds that avoid prosthetic rejection. Additionally, cardiac scaffolds for paediatric CHD can be implanted as acellular prostheses, or recellularised before implantation, and cellularisation techniques will be extensively discussed.

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