Suitability of stentless bioprostheses for combined replacement of the aortic valve and ascending aorta.
BACKGROUND
The Edwards Prima stentless valve (EPSV) is a bioprosthesis made of the porcine aortic root which, owing to its versatility, may be implanted with different techniques depending on the underlying disease. The aim of this study was to demonstrate the usefulness of the EPSV implanted as a miniroot in patients with disease of the aortic valve and ascending aorta.


METHODS
Between January 1998 and July 2002, 91 patients (mean age 67 +/- 7 years) underwent combined replacement of the aortic valve and ascending aorta with an EPSV for aortic stenosis (n = 12), incompetence (n = 45) or mixed disease (n = 26); all had aneurysmal dilation of the ascending aorta and 8 had an acute aortic dissection. The EPSV was implanted using the miniroot (or inclusion) technique and by extending the aorta with a tubular graft; aortic arch replacement was required in 5 patients. Hospital survivors underwent clinical and echocardiographic follow-up at 6 and 12 months and yearly thereafter.


RESULTS
The hospital mortality was 11% (10 patients). Causes of death included stroke (n = 3), septic shock (n = 3), myocardial infarction (n = 2), and low output syndrome (n = 2). The mean follow-up of the 81 discharged patients was 16 +/- 13 months and was 100% complete; there were 6 late deaths due to non-cardiac causes. All patients presented with clinical improvement (95% are in NYHA functional class I) with low transvalvular gradients and significant regression of left ventricular hypertrophy at two-dimensional echocardiography.


CONCLUSIONS
The EPSV used as a miniroot has proved to be a valid option in patients requiring simultaneous replacement of the aortic valve and ascending aorta. Due to the limited information available on the long-term fate of the porcine aortic valve and root, the use of this device as a miniroot should presently be limited to elderly patients.
Auriemma
Stefano
S
Division of Cardiac Surgery, San Bortolo Hospital, Vicenza, Italy. stefanoauriemma@virgilio.it
Bortolotti
Uberto
U
Piccin
Caterina
C
Brunelli
Massimo
M
Magagna
Paolo
P
Lamascese
Nicola
N
Paccanaro
Mariemma
M
Fabbri
Alessandro
A
D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D001011:Aorta / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001705:Bioprosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011336:Probability; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome