Is the Freedom Solo Stentless Bioprosthesis a Useful Tool for Patient with Aortic Endocarditis and Aortic Annular Destruction?

Objectives: The implantation of The Freedom SOLO stentless bovine-pericardial prosthesis (FS) with a supra-annular implantation technique can be a valuable option for patients with endocarditic annular destruction. We assessed early and long-term outcome following the use of this prosthesis in extensive aortic valve endocarditis.

Methods: From 2006 to 2016, fifty-nine patients with extensive aortic endocarditis underwent aortic valve replacement with FS (cumulative 263 patients/years) in three European centers, all patient presented annular and peri-annular tissue infection, in 54.3% of patient annular abscess was present.

Results: The mean age was 66 ± 11 years. The mean EuroSCORE I was 30.3 ± 15.1. In our series 22% of patients had prosthetic valve endocarditis. Early mortality was 15.2% (9 patients). Estimated overall survival at 5 and 10 years were 68.9%±6.1% and 59.1%±7.7% respectively (Linearized-rate 4.21%/valve years). At 10-years survival freedom from valve-related-death was 83.7%±2.8%. No structural valve was reported in this series. Two patients underwent reoperation for recurrent endocarditis, and 5 patients had recurrent endocarditis during follow-up. Survival freedom rates from reoperation an endocarditis at 10-years follow-up were 88.0 ± 7.6% and 83.0 ± 6.4% respectively. No patient had more than mild aortic regurgitation.

Conclusion: Freedom SOLO stentless bioprostheses is a valuable option to achieve aortic valve replacement in patients with aortic endocarditis and aortic annular destruction. Although early mortality remains considerable in this high-risk group of patients, late outcomes are comparable to conventional and homograft bioprostheses with low rates of recurrence of endocarditis.