Reintervention after aortic root replacement with allograft, xenograft, and stented bioprosthetic valves

Background: There has been a significant increase in the utilization of non-mechanical valves in the aortic position over time. However, details in reinterventions after aortic root replacement (ARR) with non-mechanical prosthesis were limited in the literature, despite the potential importance of reinterventions in the lifetime management of aortic valve disease.

Methods: This is a single-center retrospective study, identifying all patients who underwent ARR with allograft, xenografts, and stented bioprosthetic valved conduit from 2010 to 2020. Cumulative incidence was plotted for aortic valve reintervention.

Results: A total of 523 patients underwent ARR with non-mechanical valves: allograft (n = 80, 15.3 %), xenograft (n = 267, 51.1 %), and stented bioprosthetic valved conduit (n = 176, 33.7 %). The mean age was 65.9 years old. A history of infective endocarditis was seen in 124 (23.7 %). Overall, valve reintervention was observed in 21 (4.0 %). The median time to reintervention was 4.77 years. The reason for valve reintervention included structural valve deterioration (n = 12), followed by infective endocarditis (n = 6), complication during mitral valve replacement (n = 1), cardiac mass (n = 1), and pseudoaneurysm (n = 1). None of the reinterventions were transcatheter-based. Expected reintervention rates were 8.1 ± 2.0 % at 10 years. Cox hazard regression analysis revealed ejection fraction <30 and heart failure were independently associated with long-term mortality while type of valve was not.

Conclusions: Aortic valve reintervention was infrequent. Although subsequent valve in valve transcatheter intervention is often discussed when implanting non-mechanical valves, it was not a common strategy after ARR in our experience. The type of valve was not related to long-term mortality.