title: Composite stentless valve with graft extension for combined replacement of the aortic valve, root and ascending aorta.
abstract: OBJECTIVE
  The composite mechanical valve conduit has been most commonly used for patients who require combined aortic valve, root, and ascending aorta replacement, but is limited, especially in the elderly, because of the need for long-term anticoagulation. We report the first consecutive series of patients in whom a composite stentless valve with graft extension, which does not require long-term anticoagulation, was performed.
  
  
  METHODS
  Between April 1998 and July 2000, eight patients with severe aortic root and ascending aortic pathology underwent a combined aortic valve, root, and ascending aorta replacement with a Freestyle stentless porcine valve with a Hemashield graft extension. Mean age was 74 (range 56--82), three were males. Concomitant procedures included coronary artery bypass graft (CABG) alone (n=2), mitral valve replacement with atrial septal defect repair (n=1) and CABG with septal myomectomy (n=1).
  
  
  RESULTS
  Operative mortality was zero. Median aortic cross-clamp and cardiopulmonary bypass times were 150 and 203 min, respectively. Two patients returned to the operating room for bleeding. Median blood transfusions and hospital length of stay were 4 units and 11 days, respectively.
  
  
  CONCLUSIONS
  The composite stentless valve with graft extension is a reasonable alternative to a mechanical valve conduit for patients who require a combined aortic valve, root, and ascending aorta replacement, in whom anticoagulation is not desirable or contraindicated.
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA. jbyrne@partners.org
authors.forename: J G
authors.initials: JG
authors.lastname: Byrne
authors.forename: T
authors.initials: T
authors.lastname: Mihaljevic
authors.forename: W E
authors.initials: WE
authors.lastname: Lipson
authors.forename: B
authors.initials: B
authors.lastname: Smith
authors.forename: J A
authors.initials: JA
authors.lastname: Fox
authors.forename: S F
authors.initials: SF
authors.lastname: Aranki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D001705:Bioprosthesis; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design