title: Valved stentless composite graft: clinical outcomes and hemodynamic characteristics.
abstract: BACKGROUND
  The valved stentless composite graft has become well established in our hospital for replacement of the ascending aorta and aortic valve in elderly patients and those with contraindication for lifelong anticoagulation. This study was conducted to evaluate the postoperative hemodynamic characteristics and clinical outcomes after implantation of this device.
  
  
  METHODS
  Between November 1998 and February 2001, 45 consecutive patients with a mean age of 69 years underwent implantation of a composite graft using a stentless valve prosthesis (Toronto SPV) incorporated in a collagen-coated Dacron tube (InterGard). The indication for surgery was aortic valve disease with an accompanying true aneurysm of the ascending aorta in 42 patients and a dissection of the aortic wall in 3 patients. Postoperative echocardiographic examinations were performed before discharge from the hospital and at the time of the follow-up. Mean follow-up duration was 18 months (range 3 to 30 months).
  
  
  RESULTS
  There was no perioperative mortality. During follow-up, there were two noncardiac, nonvalve-related deaths. Echocardiographic evaluation before discharge and at follow-up demonstrated favorable hemodynamics of the valve prosthesis with mean transvalvular gradients of 8.5 +/- 2.9 mmHg and 8.0 +/- 3.1 mmHg, respectively. No regurgitation across the valve and no contact of the cusps with the Dacron tube were seen in any case.
  
  
  CONCLUSIONS
  A stentless composite graft for replacement of the aortic valve and ascending aorta offers excellent hemodynamic results and is a suitable device for patients in whom anticoagulation should be avoided.
authors.affiliation: Herz- und Gefaess-Klinik, Bad Neustadt, Germany. urbanski@kardiochirurg.de
authors.forename: Paul P
authors.initials: PP
authors.lastname: Urbanski
authors.forename: Anno
authors.initials: A
authors.lastname: Diegeler
authors.forename: Alexander
authors.initials: A
authors.lastname: Siebel
authors.forename: Michael
authors.initials: M
authors.lastname: Zacher
authors.forename: Robert W
authors.initials: RW
authors.lastname: Hacker
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery*; D001021:Aortic Valve; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000150:complications / Q000601:surgery; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011474:Prosthesis Design; D016896:Treatment Outcome