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Aortic Root Reconstruction with Bioprosthetic Valved Conduits: Reviewing a Consecutive Series of 275 Procedures
C. D. Etz, T. M. Homann, N. Rane, C. A. Bodian, F. Kilburn-Toppin, G. Diluozzo, K. Plestis, R. B. Griepp. Mount Sinai School of Medicine, New York, NY,
BACKGROUND: To assess the results of aortic root reconstruction using composite conduits with stented bioprosthetic valves.
METHODS: 275 patients (202 male, mean age 69±11, range 17-88) who had aortic root replacement using conduits constructed intraoperatively from pericardial valves and impregnated Dacron grafts from 9/93 to 2/05 underwent review. There were 141 patients with degenerative and 63 with atherosclerotic aneurysms; 43 had dissections (14 acute type A), 14 had endocarditis, and 10 had other pathologies. Only the ascending aorta was replaced in 154 patients; a hemiarch reconstruction was performed in 105, and extensive arch reconstruction in 16. Hypothermic circulatory arrest was used in 240 patients.
RESULTS: Hospital mortality was 17/275 patients (6.2%). Four additional patients (1.5%) sustained permanent strokes. Table 1 outlines factors contributing to these acute adverse outcomes*. A Kaplan-Meier curve of long-term survival is shown in Figure 1. Among surviving patients, the rate of stroke was estimated as 1.5, and of significant hemorrhage as 0.65 per 100 patient-years. Reoperation for valve failure did not occur in the first postoperative decade.
CONCLUSIONS: Patients who recover satisfactorily after reconstruction of the aortic root with a stented bioprosthetic valved conduit (6 month survivors) enjoy long-term outcomes equivalent to a normal matched population.
Risk Factors for Adverse Short-term Outcome | Prevalence of risk factors | Predictors for acute adverse event* | | Factors | N= | (%) | univariate | multivariate | | Age > 60 years | 226 | 82.2% | - | - | | Coronary artery disease | 96 | 34.9% | p = 0.02 | - | | History of neurologic dysfunction | 24 | 8.7% | - | - | | Urgent / emergent procedure | 30 | 10.8% | - | - | | Clot or atheroma | 24 | 8.7% | p < .0001 | p = 0.0002 | | Concomitant procedure | 114 | 41.2% | p = 0.04 | p = 0.02 | | . | | * stroke or death |
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