Risk Predictors for Long-Term Outcomes in Patients Undergoing REDO Isolated Aortic Valve Replacement with Sutureless Versus Sutured Bioprosthesis

Objective: Long-term clinical outcomes in patients undergoing redo aortic valve replacement with sutured (SAVR) and sutureless aortic bioprosthesis remain hindered. We sought to evaluate risk predictors that influence survival after redo-SAVR versus redo-sutureless Aortic Valve Replacement (AVR). Methods: All consecutive 82 patients undergoing isolated redo-AVR with either SAVR or sutureless bioprosthesis between 08/2010-03/2020 at our institution were included. Patients with concomitant procedures were excluded from the analysis. Primary outcome was analyses of long-term all- cause mortality. A propensity-adjusted analysis was used to compare groups. Kaplan-Meier were constructed to evaluate long-term survival. Results: Preoperatively, redo-SAVR (n=57) and redo-sutureless (n=25) patients baseline characteristics were compared. Mean age was 67.2 vs. 68.5-year-old and mean Euroscore II 11% vs. 7.5%, in redo-SAVR vs. redo-sutureless, respectively. Intraoperatively, redo-SAVR experienced a higher cardiopulmonary (p=0.23) and aortic cross-clamp time (p=0.002) compared to redo- sutureless group. Postoperatively, only new incidence of Atrial Fibrillation (POAF) was higher in redo-SAVR group. Primary outcome of all-cause death at 5-years follow-up was redo-SAVR 7/57 (12.2%) vs. redo-sutureless 2/25 (8%), p=0.82; (HR 1.3 [0.2, 7.5]). New risk predictors for mortality in patients undergoing redo-SAVR included body mass index ≥ 30 kg/m2 HR (1.21 [1.04, 1.5]), and tobacco use HR (11.1 [1.1, 112.3]). Conclusion: Patients undergoing redo-SAVR experienced a higher incidence of POAF compared to patients undergoing redo sutureless valves. There were no differences on long-term all-cause death among groups.