Related Experiment Video
Updated: Jul 24, 2026
Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
Composite valve graft versus separate aortic valve and ascending aortic replacement: is there still a role for the
K L Yun1, D C Miller, J I Fann
1Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, Calif 94305-5247, USA.
Insights
Composite valve grafts (CVG) and separate graft-valve (GV) procedures for aortic root replacement showed similar long-term outcomes. Proper patient selection is key for successful aortic root repair, regardless of technique.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Medical Device Technology
Background:
- Aortic root replacement is a complex procedure for treating aortic valve disease and ascending aortic aneurysms.
- Two common techniques include composite valve graft (CVG) and separate graft-valve (GV) replacement.
- The choice of technique may influence patient outcomes.
Purpose of the Study:
- To compare the surgical outcomes of aortic root replacement using CVG versus GV.
- To identify factors influencing operative mortality, late death, and reoperation rates.
Main Methods:
- Retrospective analysis of 390 consecutive patients undergoing aortic root replacement between 1965 and 1995.
- Patients received either CVG (n=135) or GV (n=255).
- Follow-up averaged 2247 patient-years, with 96% completeness.
Main Results:
- Operative mortality rates were similar between CVG (10%) and GV (15%) groups (P=NS).
- 15-year actuarial survival was higher for the CVG group (53%) versus GV group (36%) (P=.037).
- Freedom from reoperation at 10 years was similar (CVG: 82%, GV: 75%; P=NS). Multivariate analysis indicated procedure type was not a significant predictor of outcomes.
Conclusions:
- Long-term results for CVG and GV aortic root replacement are comparable, emphasizing the importance of patient selection.
- CVG may offer theoretical advantages for younger patients, Marfan syndrome, and extensive aortic root pathology.
- Separate GV replacement remains a viable option in carefully selected patients.
Background:
To ascertain if operative technique has any bearing on outcome, the surgical results after aortic root replacement using either a composite valve graft (CVG) or a separate graft and valve (GV) were analyzed.
Methods And Results:
Three hundred and ninety consecutive, nonrandomized patients treated for aortic valve disease and ascending aortic aneurysm (n=278) or type A dissection (n=112 [45 acute]) between 1965 and 1995 were analyzed retrospectively. One hundred and thirty-five patients received a CVG, and 255 had separate GV replacement. Mean age was 52+/-16 years (+/-1 SD). Eighty-two patients (44% of the CVG group) had the Marfan syndrome (MFS). Follow-up (96% complete) totaled 2247 patient-years and extended to 27 years. The operative mortality rate was 10+/-3% (+/-70% confidence limits) for patients receiving a CVG and 15+/-2% for GV replacement (P=NS). The 15-year actuarial survival estimate was higher for the CVG group (53+/-14% [+/-SEM] versus 36+/-4%, P=.037). Seven patients in the CVG group required reoperation on the aortic valve or ascending aorta, as did 49 in the GV group. The probabilities of freedom from reoperation on the aortic rootwere 82+/-9% and 75+/-4% at 10 years for the CVG and GV group (P=NS). Thirty variables were analyzed in a multivariate model: pulmonary disease, higher New York Heart Association functional class, and longer cardiopulmonary bypass time were linked with higher operative mortality risk; older age, emergency operation, coronary artery disease, and liver dysfunction were independent determinants of late death. Younger age and use of a bioprosthesis were predictors of late reoperation. Type of procedure (GV versus CVG) was not a significant predictor of any outcome variable.
Conclusions:
The long-term results after CVG or GV were similar, which reflects proper patient selection. Use of a composite valve graft theoretically confers more protection against recurrent aortic root aneurysm, and, unless one opts for a valve-sparing aortic root replacement procedure, is most appropriate for younger patients, those with the MFS (including acute dissections), and others with marked pathological involvement of the sinuses. On the other hand, use of a separate GV should not be abandoned; in carefully selected patients (and if properly performed, eg, excision of the sinuses), GV also provides satisfactory results.
