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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Long-term performance of the Hancock bioprosthetic valved conduit in the aortic root position
Catalin C Badiu1, Sabine Bleiziffer, Walter B Eichinger
1Department of Cardiovascular Surgery, German Heart Center, Munich, Germany. badiu@dhm.mhn.de
Insights
Long-term outcomes of aortic root replacement using the Hancock bioprosthetic porcine conduit show reasonable survival but inferior prosthesis durability compared to stented valves. A key advantage is simplified redo procedures.
Area of Science:
- Cardiovascular Surgery
- Biomaterials Science
- Prosthetic Valve Technology
Background:
- Aortic root replacement is a critical procedure for various aortic pathologies.
- The Hancock bioprosthetic porcine conduit has been used for aortic root replacement.
- Assessing long-term outcomes, including prosthesis durability, is essential.
Purpose of the Study:
- To evaluate long-term morbidity and mortality after aortic root replacement with the Hancock bioprosthetic porcine conduit.
- To specifically assess the durability of the Hancock bioprosthetic porcine conduit.
- To identify benefits and limitations of this prosthesis in a demanding patient cohort.
Main Methods:
- A retrospective study of 81 patients undergoing aortic root replacement with the Hancock conduit between 1975 and 2004.
- Inclusion criteria: aortic dissection, ascending aortic aneurysm, porcelain aorta.
- Follow-up was 98% complete, with a mean of 4.8 years; actuarial event-free rates were calculated.
Main Results:
- Actuarial survival rates at 5 and 10 years (excluding operative deaths) were 77.0% and 54.0%, respectively.
- Freedom from structural valve deterioration at 5 and 10 years was 88.1% and 49.9%, respectively.
- Simplified redo procedures were noted, avoiding a second Bentall operation.
Conclusions:
- Long-term survival after aortic root replacement with the Hancock bioprosthetic conduit is reasonable in complex cases.
- Prosthesis durability is inferior to stented Hancock valve substitutes.
- The primary benefit lies in the simplified approach for subsequent reoperations.
Background And Aim Of The Study:
The study aim was to assess long-term morbidity and mortality with special regard to prosthesis durability after aortic root replacement with the Hancock bioprosthetic porcine conduit.
Methods:
Between 1975 and 2004, a total of 81 patients (55 males, 26 females; mean age 58 +/- 18 years) underwent aortic root replacement with the Hancock conduit for aortic dissection (n = 22; 27%), ascending aortic aneurysm (n = 57; 70%), or porcelain aorta (n = 2; 3%). Twenty-five patients (31%) underwent an emergency operation, 12 (15%) presented with Marfan syndrome, and eight (10%) had undergone previous cardiac surgery. Concomitant procedures were performed in 26 cases (32%). The follow up was 98% complete; the mean follow up was 4.8 +/- 4.0 years (range: 1 day to 16.7 years), and the cumulative follow up was 403 patient-years. Actuarial event-free rates were calculated, and valve-related complications classified according to guidelines for reporting morbidity and mortality after cardiac valvular operations.
Results:
There were seven (9%) operative deaths and four (5%) in-hospital deaths. Actuarial survival rates at five and 10 years (excluding operative deaths) were 77.0 +/- 5.3% and 54.0 +/- 7.5%, respectively. Actuarial freedom from aortic valve reoperation at five and 10 years was 98 +/- 1.6% and 64 +/- 10.2%, from structural valve deterioration 88.1 +/- 4.7% and 49.9 +/- 9.6%, from thromboembolic events 87.4 +/- 4.6% and 75.1 +/- 9.5%, and from major bleeding events 90.2 +/- 3.9% and 75.4 +/- 8.1%, respectively. Among redo procedures, the stentless Hancock valve could be excised without separating the synthetic graft from the left ventricular outflow tract, and a stented valve prosthesis thus implanted. Hence, it was possible to avoid a second Bentall operation.
Conclusion:
The long-term survival rates after aortic root replacement with the bioprosthetic Hancock conduit were reasonable for this demanding patient cohort. However, the durability of the prosthesis was inferior to that reported for the stented Hancock valve substitute. The key benefit of this bioprosthetic valved conduit was the simplified redo procedure.
