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Valved stentless composite graft: clinical outcomes and hemodynamic characteristics
Paul P Urbanski1, Anno Diegeler, Alexander Siebel
1Herz- und Gefaess-Klinik, Bad Neustadt, Germany. urbanski@kardiochirurg.de
Insights
The stentless composite graft effectively replaces the aortic valve and ascending aorta, showing excellent hemodynamic results. This device is suitable for patients who cannot take lifelong anticoagulation medication.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Medical Devices
Background:
- The valved stentless composite graft is established for aortic valve and ascending aorta replacement in specific patient groups.
- This includes elderly patients and those with contraindications for lifelong anticoagulation.
Purpose of the Study:
- To evaluate the postoperative hemodynamic characteristics and clinical outcomes of the valved stentless composite graft.
- Assessing the efficacy and safety of this device in a clinical setting.
Main Methods:
- A cohort of 45 patients (mean age 69 years) received the stentless valve prosthesis (Toronto SPV) within a Dacron tube (InterGard).
- Indications included aortic valve disease with ascending aorta aneurysm (42 patients) or aortic dissection (3 patients).
- Postoperative echocardiography was performed before discharge and during a mean 18-month follow-up.
Main Results:
- No perioperative mortality was observed.
- Two non-cardiac, non-valve-related deaths occurred during follow-up.
- Favorable hemodynamics were demonstrated with low mean transvalvular gradients (8.5 mmHg pre-discharge, 8.0 mmHg follow-up) and no regurgitation or cusp contact.
Conclusions:
- The stentless composite graft provides excellent hemodynamic performance for aortic valve and ascending aorta replacement.
- It is a suitable alternative for patients who must avoid anticoagulation therapy.
Background:
The valved stentless composite graft has become well established in our hospital for replacement of the ascending aorta and aortic valve in elderly patients and those with contraindication for lifelong anticoagulation. This study was conducted to evaluate the postoperative hemodynamic characteristics and clinical outcomes after implantation of this device.
Methods:
Between November 1998 and February 2001, 45 consecutive patients with a mean age of 69 years underwent implantation of a composite graft using a stentless valve prosthesis (Toronto SPV) incorporated in a collagen-coated Dacron tube (InterGard). The indication for surgery was aortic valve disease with an accompanying true aneurysm of the ascending aorta in 42 patients and a dissection of the aortic wall in 3 patients. Postoperative echocardiographic examinations were performed before discharge from the hospital and at the time of the follow-up. Mean follow-up duration was 18 months (range 3 to 30 months).
Results:
There was no perioperative mortality. During follow-up, there were two noncardiac, nonvalve-related deaths. Echocardiographic evaluation before discharge and at follow-up demonstrated favorable hemodynamics of the valve prosthesis with mean transvalvular gradients of 8.5 +/- 2.9 mmHg and 8.0 +/- 3.1 mmHg, respectively. No regurgitation across the valve and no contact of the cusps with the Dacron tube were seen in any case.
Conclusions:
A stentless composite graft for replacement of the aortic valve and ascending aorta offers excellent hemodynamic results and is a suitable device for patients in whom anticoagulation should be avoided.