Utility of the full root bioprosthesis in surgery for complex aortic valve-ascending aortic disease

The objective of this study was to demonstrate the use of the full root bioprosthesis (Medtronic Freestyle) in the patient with complex aortic valve-ascending disease. Of 148 patients undergoing stentless aortic valve replacement since 4/98, 22 required concomitant replacement of the entire ascending aorta with a Dacron graft (beveled to include hemi-arch) for either "porcelain" aorta (8) or diffuse aneurysmal dilatation (14): 17/22 had aortic stenosis, 4/22 had aortic insufficiency, and 1 had bioprosthetic degeneration. All patients had right axillary cannulation, circulatory arrest at 18 C, and retrocerebral perfusion through the superior vena cava. Valve sizes included 23 mm (7), 25 mm (2), and 27 mm (13). Average age was 69.5 years, average intensive care unit stay was 64 hours, and average postoperative length of stay was 6.5 days. Although the initial intent was full root replacement, 7 patients had calcified coronary ostia precluding reimplantation. Subcoronary implantation techniques were modified to interdigitate the outflow suture lines between and through islands of calcium buttressed with small pericardial pledgets on the outside of the native aorta. All valves demonstrated either no or trace aortic regurgitation on pre-discharge transesophageal echocardiography, 30-day mortality was 0, and there were no neurologic sequelae. The full root bioprosthesis has great utility in surgery for complex aortic valve-ascending aortic disease. Axillary artery cannulation and retrograde cerebral perfusion provide a reproducible neurologically safe approach in this group of patients at high risk for intraoperative neurologic morbidity.