Eight years clinical experience with the replacement of the ascending aorta using composite xenopericardial conduit

The evaluation of early and late results after ascending aorta replacement with composite glutaraldehyde-treated xenopericardial valved conduit.

From December 1989 to May 1999 the ascending aorta was replaced with 148 composite xenopericardial conduits aorta in 145 patients. Biological valves were inserted in 28 conduits, mechanical valves - in 116. The age of 40 female (28%) and 105 male (72%) patients ranged from 10 to 60 years (mean, 38.7+/-12 years). The original diseases were: atherosclerosis in 51 (35%), cystic media necrosis in 50 (35%), Marfan syndrome in 35 (24%), syphilis in three (2%), non-specific aortitis in one (0.7%), Turner syndrome in one and infective endocarditis in four cases. Aortic dissection was found in 67 patients (46%): type I in 14 (23%) and type II in 53 (77%). Twenty-one patients (15%) were operated on during the acute phase of the dissection. The Bentall-DeBono technique was used in 144 operations, in four cases (2.7%) supracoronary resection was performed. Associated procedures included: mitral valve repair (five), CABG (four), resection of the coarctation (two), MV replacement (two). Biological tissues condition was assessed using TTE TEE and computed tomography (CT) scanning technique.

Hospital mortality was 8.3 % (12 patients). The death was caused by: low cardiac output (three), arrhythmia (two), neurological complications (one), sepsis (one), polyorgan failure (four), bleeding (one). Non-lethal complications included: bleeding (four), heart failure (two), persisting A-V block (two), polyorgan failure (three), cerebral (two), mediastinitis (three), and early prosthetic endocarditis in three patients. All three patients with endocarditis were successfully re-operated and conduit replaced with the same type of the device. Late follow-up ranged from 2 months to 8 years (mean, 51 months) and complete in 87% of the discharged patients (115 patients). There were four valve-related deaths due to thrombembolia and five deaths non related to the valve and/or conduit. Clinical and instrumental evaluation did not reveal any signs of tissue degeneration at the conduit and biovalves' cusps.

The xenopericardial valved conduit is an effective and acceptable device for the replacement of ascending aorta in almost all cases, it provides good early and late results. It's pliability and elasticity are especially attractive in situations with frail tissues and high risk of bleeding.