Risk factors for coronary complications after stentless aortic root replacement

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Cardiac Surgery

Background:

• Coronary complications are a concern following aortic root replacement (ARR) using stentless biological conduits.
• Pulmonary autografts have been anecdotally associated with higher rates of coronary complications compared to homografts or xenografts.

Purpose of the Study:

• To investigate the hypothesis that pulmonary autografts lead to more frequent coronary complications after stentless aortic root replacement.
• To compare outcomes between patients undergoing ARR with pulmonary autografts versus other stentless biological conduits.

Main Methods:

• Retrospective review of 84 consecutive patients undergoing stentless aortic root replacement (ARR) between January 1992 and January 1999.
• Patients were divided into two groups: 50 with autograft (Group 1) and 34 with homograft or xenograft (Group 2).
• Comparison of demographic data, preoperative conditions, operative times, and postoperative outcomes, including coronary complications.

Main Results:

• No significant differences in age, sex, aortic root disease, coronary anomalies, or prior procedures were found between groups.
• Bicuspid aortic valve was significantly more prevalent in the autograft group (56% vs. 9%).
• Coronary complications occurred more frequently in the autograft group (10% vs. 3%), primarily causing right ventricular ischemia. Bicuspid aortic valve and coronary anomalies were risk factors for these complications.

Conclusions:

• Stentless aortic root replacement (ARR) is a safe procedure with low operative mortality, irrespective of the biological conduit used.
• Autograft ARR may carry an increased risk of right ventricular ischemia in patients with bicuspid aortic valves and coronary anomalies.
• Aggressive intraoperative management, including partial takedown of repair, can effectively manage coronary complications and limit morbidity.