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Simultaneous myocardial revascularization and aortic valve replacement: stentless versus stented bioprostheses
J Ennker1, J Bauer, U Rosendahl
1The Heart Institute Lahr/Baden, Germany.
Insights
Stentless aortic valve replacement, while longer, can be safely combined with myocardial revascularization. This combined procedure does not increase the risk compared to isolated valve replacement in carefully selected patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Devices
Background:
- Stentless aortic valve prostheses implantation is technically demanding and time-consuming.
- Concomitant myocardial revascularization can further prolong operative duration.
Purpose of the Study:
- To evaluate surgical aspects and outcomes of stentless aortic valve implantation.
- To assess the safety of simultaneous myocardial revascularization with stentless aortic valve replacement.
Main Methods:
- Retrospective review of 303 patients undergoing aortic valve surgery (April 1996-April 1999).
- Procedures included isolated aortic valve replacement or combined with coronary artery bypass grafting.
- Implantation techniques: subcoronary, root inclusion, and total root replacement using Medtronic Freestyle valve.
Main Results:
- Overall hospital mortality was 5.6%, with 4.7% for isolated valve replacement and 6.7% for combined procedures.
- Patients unsuitable for stentless valves due to aortic root calcification had higher mortality.
- Simultaneous myocardial revascularization with stentless prostheses did not increase perioperative risk.
Conclusions:
- Stentless aortic valve implantation, even with combined procedures, can be performed safely.
- Careful patient selection is crucial, especially regarding aortic root condition.
- Simultaneous myocardial revascularization is a viable option without increased risk in this cohort.
Abstract:
Implantation of stentless aortic valve prostheses is more time-consuming than implantation of conventional stented bioprostheses. Simultaneous myocardial revascularization can result in a considerably prolonged operation time. We reviewed our patients with regard to surgical aspects in the specific patient cohorts. From April 1996 to April 1999, 303 patients were operated for aortic valve disease with or without concomitant coronary artery revascularization. Mean age was 75 years, ranging between 36 and 90 years. Using the Medtronic Freestyle valve, the following techniques of implantation were used: subcoronary technique, 163 patients, 61.5%; root inclusion technique, 7 patients, 3.5%; total root replacement, 30 patients, 15%. Total hospital mortality rate was 5.6%, reflecting age and concomitant disease of these patients. For isolated aortic valve replacement, the mortality rate was 4.7% and 6.7% for combined procedures. Coronary artery patients who are not suitable for stentless valve implantation owing to extensive aortic root calcification have a higher perioperative mortality rate. Compared with the isolated valve replacement and despite more extensive surgery and prolonged operative time, simultaneous myocardial revascularization in patients with stentless prostheses implantation can be performed without an increased risk.