Abstract 17048: Fifteen Year Follow-Up After Aortic Root Replacement with Stentless Biological Valve Conduits: Homograft versus Freestyle
Bibliographic record
Abstract
Objectives: The choice of biologic aortic valve substitute for aortic root replacement is multifaceted. Herein, we report the compared long-term outcome of two type of stentless biologic valve conduits namely homograft and Fresstyle bioprosthesis used to replace the aortic root and followed prospectively up to 15 years. Methods: Between 1993 and 2011, 188 patients underwent elective primary aortic root replacement with a stentless bioprosthetic aortic valve with (n=38) or without (n=150) CABG. Among these patients, 98 Freestyle and 90 homografts were implanted. All clinical and echocardioraphic data were collected prospectively. Mean overall follow-up was 8.5±3.9 years (range: 0.1-15). It was 8.4±3.8 years for Freestyle, and 8.5±4.0 years for homografts, and complete in all patients. Results: Patient characteristics were comparable between groups except for age and number of pre-operative diagnosis of endocarditis ( p <0.0001) and moderate/severe aortic insufficiency ( p <0.008). The mean age was significantly higher in the Freesstyle (65.4±8.5years) compared to homograft (48.1±13.0 years) group ( p < 0.0001). Hospital mortality was comparable between the Freestyle and the homograft group (5.1% versus 7.8%, p =0.6). Ten and 15-years survival was 66.7% and 53.0% in the Freestyle versus 89.9% and 69.1% in the homograft group, respectively ( p <0.001). Freedom from reoperation due to structural valve deterioration (SVD) at 10 and 15 years was 98.8% and.92.7% for the Freestyle compared to 87.4% and 68.6% in the homografts group, respectively ( p =0.009). Independent risk factors for reoperation for SVD were age (OR:1.1, CI: 1.02-1.1, p =0.002), and use of homograft (OR:7.7, CI: 1.7-35.5, p =0.008). Independent risk factors for poorer long-term survival were age (OR 1.2, CI: 1.1-1.3, p =0.001), and lenght of hospital stay (OR 2.9, CI: 1.5-3.8, p =0.0003). Mean pressure gradient at the end of follow-up was 8.5±6.2 mm Hg for the Freestyle and 9.9±9.1 mm Hg for the homograft patients. Conclusion: The choice of stentless biologic valve for aortic root reconstruction have no influence on early and long-term survival. The use of biologic root reconstruction with Freestyle bioprostheses provides a better freedom from reoperation due to SVD compared to homografts.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".