Aortic root replacement with a new stentless aortic valve xenograft conduit: preliminary hemodynamic and clinical results.
OBJECTIVE
Beside aortic valve-sparing surgery, a composite graft, homograft or (more rarely) an autograft are the most common options to replace a diseased or destroyed aortic root in adults. Recently, a new stentless xenograft valved conduit (Shelhigh, No-React) was introduced in Europe. This totally biologic conduit is glutaraldehyde cross-linked, detoxified and heparin-treated with No-React; this process eliminates residual glutaraldehyde and ensures stable tissue cross-linking. The initial clinical and hemodynamic results with this porcine valved conduit in the aortic position are presented herein.


METHODS
Among 308 patients who underwent thoracic aorta surgery during a 30-month period, 127 had aortic root repair or replacement. The Shelhigh stentless aortic valve conduit was implanted in 35 patients (30 males, 5 females; mean age 68 +/- 7.2 years; mean body mass index 27.5 +/- 4.1 kg/m2). Of these patients, 15 had aortic valve stenosis and ascending aortic aneurysm, 10 had a dilated aortic root with or without aortic regurgitation, four had acute aortic dissection type A, and six had a complex pathology (destructive endocarditis or re-do surgery).


RESULTS
One patient with prosthetic valve endocarditis died on postoperative day 1 from uncontrolled septicemia (30-day mortality, 2.7%). There were no conduit-related adverse events in the surviving patients, but one re-exploration was required for bleeding in a re-do case. Transthoracic echocardiography was available in 30 patients after six months, and in 15 patients after 12 months. The mean gradient across the aortic valve was 8.5 +/- 5.1 mmHg (range: 6 to 14 mmHg for conduit sizes 21 to 29 mm).


CONCLUSIONS
The Shelhigh valved conduit shows promising hemodynamic properties. As the conduit contains no fabric or mechanical components, it is ideal for treatment of the infected aortic root, and an excellent alternative to homografts. In older patients, this conduit has the additional advantage that no long-term anticoagulation is required.
Carrel
Thierry P
TP
Clinic for Cardiovascular Surgery, University Hospital Berne, Switzerland.
Berdat
Pascal
P
Englberger
Lars
L
Eckstein
Friedrich
F
Immer
Franz
F
Seiler
Christian
C
Kipfer
Beat
B
Schmidli
Jürg
J
D000328:Adult; D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006350:Heart Valve Prosthesis; D006439:Hemodynamics / Q000502:physiology*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate; D014183:Transplantation, Heterologous / Q000009:adverse effects / Q000379:methods*