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Composite stentless valve with graft extension for combined replacement of the aortic valve, root and ascending aorta
J G Byrne1, T Mihaljevic, W E Lipson
1Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA. jbyrne@partners.org
Insights
This study introduces a novel composite stentless valve with graft extension for aortic valve, root, and ascending aorta replacement, avoiding long-term anticoagulation. This procedure offers a safe alternative for elderly patients unsuitable for mechanical valves.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Biomaterials in Medicine
Background:
- Composite mechanical valve conduits are standard for combined aortic valve, root, and ascending aorta replacement.
- Long-term anticoagulation required with mechanical valves poses risks, particularly for elderly patients.
- A stentless valve with graft extension offers a potential alternative to mitigate anticoagulation needs.
Purpose of the Study:
- To report the initial clinical experience with a composite stentless valve and graft extension for aortic valve, root, and ascending aorta replacement.
- To evaluate the safety and efficacy of this novel approach in patients where anticoagulation is undesirable or contraindicated.
- To present the first consecutive series of patients undergoing this specific surgical procedure.
Main Methods:
- Eight patients with severe aortic root and ascending aorta pathology underwent replacement using a Freestyle stentless porcine valve with a Hemashield graft extension.
- The patient cohort had a mean age of 74 years, with some undergoing concomitant procedures like coronary artery bypass grafting.
- Data collected included operative outcomes, perioperative management, and hospital length of stay.
Main Results:
- Zero operative mortality was observed in the series.
- Median aortic cross-clamp and cardiopulmonary bypass times were 150 and 203 minutes, respectively.
- Two patients required reoperation for bleeding; median blood transfusions were 4 units, and median hospital stay was 11 days.
Conclusions:
- The composite stentless valve with graft extension is a viable alternative to mechanical valve conduits for combined aortic valve, root, and ascending aorta replacement.
- This approach is particularly suitable for patients who cannot tolerate or do not require long-term anticoagulation.
- The initial results suggest favorable outcomes for this innovative surgical technique.
Objective:
The composite mechanical valve conduit has been most commonly used for patients who require combined aortic valve, root, and ascending aorta replacement, but is limited, especially in the elderly, because of the need for long-term anticoagulation. We report the first consecutive series of patients in whom a composite stentless valve with graft extension, which does not require long-term anticoagulation, was performed.
Methods:
Between April 1998 and July 2000, eight patients with severe aortic root and ascending aortic pathology underwent a combined aortic valve, root, and ascending aorta replacement with a Freestyle stentless porcine valve with a Hemashield graft extension. Mean age was 74 (range 56--82), three were males. Concomitant procedures included coronary artery bypass graft (CABG) alone (n=2), mitral valve replacement with atrial septal defect repair (n=1) and CABG with septal myomectomy (n=1).
Results:
Operative mortality was zero. Median aortic cross-clamp and cardiopulmonary bypass times were 150 and 203 min, respectively. Two patients returned to the operating room for bleeding. Median blood transfusions and hospital length of stay were 4 units and 11 days, respectively.
Conclusions:
The composite stentless valve with graft extension is a reasonable alternative to a mechanical valve conduit for patients who require a combined aortic valve, root, and ascending aorta replacement, in whom anticoagulation is not desirable or contraindicated.