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Modified bentall procedure with composite biologic grafts.

Jonathan A Yang1, Robert C Neely, Allan S Stewart

  • 1Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York.

Journal of Cardiac Surgery
|October 15, 2013
PubMed
Summary

The second-generation composite biologic graft (Gen2 CBG) demonstrated reduced operative times and a trend toward improved survival in aortic root replacements compared to the first generation (Gen1 CBG). Further research is needed to confirm these findings.

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Area of Science:

  • Cardiovascular Surgery
  • Biomaterials Science
  • Surgical Innovation

Background:

  • The development of ideal composite biologic grafts (CBGs) for aortic root replacement is ongoing.
  • Two generations of CBGs were utilized: Gen1 (stented pericardial valve in Valsalva graft) and Gen2 (stentless 3f valve).
  • The technique allows for graft standardization and pre-operative fabrication.

Purpose of the Study:

  • To evaluate the institutional experience with two generations of composite biologic grafts (CBGs) for aortic root replacement.
  • To demonstrate the noninferiority of the Gen2 CBG technique.
  • To discuss potential advantages of the Gen2 CBG.

Main Methods:

  • Retrospective analysis of the first 75 patients receiving each generation of CBG.
  • Primary outcome: overall survival.
  • Secondary outcomes: operative times and short-term clinical outcomes.

Main Results:

  • Gen2 CBG showed significantly reduced cardiopulmonary bypass times (126.3 ± 5.2 min vs. 157.6 ± 5.8 min for Gen1, p = 0.001).
  • Aortic cross-clamp times trended lower with Gen2 (98.2 ± 4.2 min vs. 107.7 ± 3.8 min for Gen1, p = 0.095).
  • No significant differences in postoperative myocardial infarction or aortic insufficiency; one stroke in Gen1. Kaplan-Meier survival analysis indicated a trend towards improved survival with Gen2 (p = 0.0566).

Conclusions:

  • The Gen2 CBG is associated with decreased operative times and a trend towards improved survival.
  • Further patient follow-up and larger prospective studies are required to validate these findings.
  • Continued research and improvements in CBG technology are warranted.