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Stentless full root bioprosthesis in surgery for complex aortic valve-ascending aortic disease: a single center experience of over 300 patients

Department of Cardiothoracic Surgery, Klinikum Oldenburg, Dr Eden Street 10, 26133 Oldenburg, Germany

Received 15 September 2007; received in revised form 15 December 2007; accepted 20 December 2007.

^_* Corresponding author. Tel.: +49 441 403 2820; fax: +49 441 403 2830. (Email: dapunt.otto{at}klinikum-oldenburg.de).

Objective: The technically demanding full root aortic valve replacement necessitating coronary ostia reimplantation apparently leads to hesitation by some surgeons despite the superior hemodynamics and excellent long-term clinical performances of the stentless xenografts. Clinical data of stentless full root replacements was retrospectively analyzed in this perspective for validation. Methods: From November 1999 to March 2007, 317 adult patients (male: 196, female, 121) underwent modified Bio-Bentall procedure using the Medtronic Freestyle xenograft as a full root replacement. Two hundred and three patients received an isolated root replacement or a root and ascending aortic replacement (ARR). In 114 patients a variety of concomitant procedures including coronary artery bypass grafting (n = 32), mitral valve repair (n = 11) and aortic arch replacement (n = 36) were performed. (ARR+). Results: Mean patient age was 70.3 ± 10.2 years (range 17–94 years), 97 patients were 75 and older at time of procedure. Mean operative time for the ARR was 190 ± 57 min with a clamp time of 88 ± 27 min. Mean operative time for ARR+ group was 282 ± 93 min with an average clamp time of 110 ± 32 min. Overall operative mortality was 7.9% (25/317), for ARR it was 5.4% (11/203). Mean ICU stay was 4.9 ± 8.1 days, mean hospital stay being 9.8 ± 8.1 days. Necessity for bailout bypass surgery among patients with ARR was low at 1.5% (3/203) comparable to stented xenograft implantations. Echocardiography demonstrated excellent clinical results with low transvalvular gradients especially when a single suture inflow anastomosis technique was used. Conclusions: Full root stentless valve implantation preserving porcine root integrity is a valuable option in aortic valve/ascending aorta surgery. Though technically a more challenging operation, it does not lead to increased perioperative morbidity and mortality and can be beneficial mainly for elderly patients with small aortic roots with or without aortic root pathology.

Key Words: Aortic valve replacement • Stentless valves • Full root technique