Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center Essen, Essen, Germany.
Department of Medicine, Faculty of Medicine, Imperial College London, London, UK.
J Cardiothorac Surg. 2021 Jul 28;16(1):204. doi: 10.1186/s13019-021-01583-y.
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.
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.
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 cm to 18.7 ± 4.5 cm, p = 0.029). Volume of the aortic root and the ascending aorta decreased from 137.3 ± 65.2 cm to 54.5 ± 21.1 cm after Freestyle implantation (p = 0.023).
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.
美敦力 Freestyle 假体已被证明是各种适应证主动脉根部置换的一种有前途的方法。本研究旨在评估 Freestyle 植入后的临床结果和主动脉的几何变化。
在 2005 年 10 月至 2020 年 11 月期间，对 68 例接受 Freestyle 假体主动脉根部置换术的患者的队列中的 32 例患者的计算机断层扫描血管造影（CTA）数据进行了分析。在术前（n=32）和术后（n=10）CTA 上，使用三维多平面重建，在垂直于主动脉长轴的平面上测量主动脉瓣环、主动脉根部、升主动脉和近端主动脉弓的最小和最大直径和面积。此外，还量化了主动脉根部和升主动脉的容积变化。
平均年龄为 64.6±10.6 岁。使用 Freestyle 假体的手术指征包括主动脉瓣病变、主动脉瘤或夹层以及心内膜炎，其中 28 例患者合并手术。院内死亡率为 18.6%。术前主动脉瓣环的直径和面积测量与植入瓣膜的大小密切相关（p<0.001）。28.1%的患者存在二叶式主动脉瓣。Freestyle 植入后主动脉根部直径和面积减小，导致主动脉根部容积减小（45.6±26.3cm 至 18.7±4.5cm，p=0.029）。Freestyle 植入后，主动脉根部和升主动脉的容积从 137.3±65.2cm 减少至 54.5±21.1cm（p=0.023）。
Freestyle 假体的植入在恢复主动脉几何形状方面表现出优异的结果。术前 CTA 测量有助于手术过程和瓣膜选择，因此，如果可行，应在术前计划中考虑。
