Early experiences and in-hospital results with a novel off-pump apico-aortic conduit

To offer surgical treatment in patients with aortic valve stenosis and contraindications for aortic valve replacement (e.g. ostial encroachment and previous mitral valve replacement). The aim of this study was to prove the feasibility and efficacy of this novel innovative off-pump apico-aortic conduit technique.

The bipartite conduit consists of an 18-mm prosthetic tube graft containing a stentless porcine aortic valve as well as a flexible semi-rigid and curved ventricular connector. Via left anterior lateral thoracotomy, the valved conduit is sutured to the descending aorta. The left ventricular connector is implanted with a gun-like applicator into the apex without cardiopulmonary bypass and with minimal blood loss.

Between March and December 2011, 7 patients (5 females/2 males) with a mean age of 82 (79-89 years) were operated on. The mean logistic EuroSCORE I was 36.4 ± 23.7 (median 36.7%). The mean ejection fraction was 37 (25-65%) and the mean preoperative transaortic gradient was 38 (22-53 mmHg). Three patients had previous mechanical mitral valve replacement, 1 had a porcelain aorta and 3 had unfavourable distances between the aortic annulus and ostia (ostial encroachment). Implantation was uneventful in all patients, with need for limited cardiopulmonary bypass in only 1 patient. Postoperative mean transaortic gradient was 14 (11-25 mmHg). Approximately 70% of stroke volume was bypassed as measured in postoperative magnetic resonance. One patient died in hospital due to respiratory failure. New York Heart Association class in the other patients diminished from 3.6 to 1.6. No rhythmic disturbances or heart block were encountered.

With this novel conduit, we observed excellent haemodynamic results. We feel that this additional surgical approach to aortic stenosis in elderly, high-risk patients can augment conventional on-pump and interventional treatments of aortic stenosis.