• J Heart Valve Dis · Jul 2013

    Aortic root replacement with a stented bioprosthetic valved conduit: mid-term results.

    • Giuseppe Gatti, Luca Dell'Angela, Bruno Pinamonti, Alessandro Moncada, Alessandro Minati, Bernardo Benussi, Gianfranco Sinagra, and Aniello Pappalardo.
    • Divisions of Cardiac Surgery, Cardiovascular Department, Ospedali Riuniti e Università di Trieste, Trieste, Italy. gius.gatti@gmail.com
    • J Heart Valve Dis. 2013 Jul 1;22(4):500-8.

    Background And Aim Of The StudyFor patients who require aortic root replacement but are unwilling or unable to receive anticoagulants, a composite conduit was assembled intraoperatively that contained a stented biological valve sutured inside a vascular tube graft, rather than at its extremity. This simple modification of the Bentall concept may provide several advantages. The results obtained with this conduit over an 11-year period were analyzed.MethodsBetween May 2001 and April 2012, 101 consecutive patients (mean age 68.3 +/- 9.2 years) underwent aortic root replacement with the bioprosthetic valved conduit. Aortic pathologies included degenerative disease in 61 patients (60.4%), atherosclerosis in 20 (19.8%), annuloaortic ectasia in 12 (11.9%), porcelain aorta in four (4.0%), and acute dissection in four (4.0%). The whole ascending aorta was replaced in 79 patients (78.2%); a hemiarch reconstruction and a total arch replacement were added in 18 (17.8%) and four (4.0%) patients, respectively. Hypothermic circulatory arrest was performed in 60 cases (59.4%). Forty patients (39.6%) underwent additional cardiac procedures. All perioperative data were collected prospectively.ResultsThere were five (5.0%) hospital deaths. During a mean follow up of 3.8 +/- 2.4 years there were two non-valve-related cardiac deaths and five noncardiac deaths. The seven-year actuarial survival was 79.2% (95% CI 67.0-91.4%). Bioprosthetic structural dysfunction occurred in only one patient; reoperation was easily performed by replacing the valve within the vascular graft. In the remaining 88 patients (87.1%), echocardiographic assessment showed a low transaortic mean pressure gradient (7.2 +/- 4.7 mmHg) and left ventricular wall mass reduction (p = 0.0002).ConclusionThis valved conduit is a safe and durable option for replacing the aortic root, thus facilitating the technique of implantation and simplifying reoperation in the case of valve failure.

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