[Aortic root replacement with a stentless xenograft (Freestyle®) in Iceland - indications and outcome].

Freestyle aortic root replacement was performed at low volume in Iceland, with a median of three cases per year.

• Retrospective analysis of 44 consecutive Freestyle-ARR procedures at Landspitali from 2002 to 2018.
• Annual volume ranged from 0 to 5 cases.
• The cohort represents the whole nation.

The most common indication for Freestyle-ARR was a dilated aortic root.

• Dilated aortic root accounted for 70% of cases.
• Type-A aortic dissection accounted for 9%.
• Small aortic annulus during aortic valve replacement accounted for 9%.

Patients were middle-aged to older, mostly male, and at substantial predicted surgical risk.

• Average age was 62 years and 65% were male.
• Median EuroSCORE-II was 11% (range 3-71%).

The operation was long, with extended cardiopulmonary bypass and cross-clamp times.

• Cardiopulmonary bypass time was 234 minutes.
• Cross-clamp time was 157 minutes.
• The authors describe it as a technically challenging operation.

New-onset atrial fibrillation and perioperative myocardial infarction were the most common postoperative complications.

• New-onset atrial fibrillation occurred in 51% of patients.
• Perioperative myocardial infarction occurred in 14%.
• Median postoperative length of stay was 12 days.

Thirty-day mortality was 14%, high compared with regular aortic valve replacement.

• Six of 44 patients died within 30 days.
• The authors note this is high compared with regular AVR.

Long-term survival was favourable, particularly among patients who survived the first 30 days.

• Overall Kaplan-Meier survival was 81% at 1 year and 74% at 5 years.
• For patients surviving the first 30 days, 5-year survival was 86%.
• Median follow-up was 111 months.

Late reoperations were uncommon.

• Only three patients (7%) underwent reoperation at long-term follow-up.
• The authors state reoperations were uncommon in those surviving to discharge.