title: Short-term and intermediate-term outcomes of aortic root replacement with St. Jude mechanical conduits and aortic allografts.
abstract: BACKGROUND
  Few studies have directly evaluated outcomes in patients undergoing aortic root replacement with St. Jude mechanical conduits or aortic allografts (ALLO), yet both approaches have been advocated. The purpose of this study was to provide a detailed description of outcomes in a large series of aortic root replacements performed with either St. Jude mechanical conduits or aortic allografts.
  
  
  METHODS
  A retrospective analysis was performed on 172 consecutive adult patients undergoing aortic root replacement with either St. Jude mechanical conduits (n = 73) or aortic allografts (n = 99) from January 1990 to December 2002. Maximal follow-up was 15 years, and median follow-up was 5 years.
  
  
  RESULTS
  Both groups were similar with regard to median age, preoperative ejection fraction, and New York Heart Association class. The aortic allograft patient group had a higher proportion (p < 0.05) of women (43% versus 18%), prior sternotomies (52% versus 26%), preoperative renal failure (9% versus 1%), and cerebrovascular disease (16% versus 4%). Operative indications for the aortic allograft group were more frequently endocarditis (29% versus 3%; p < 0.0001) and prosthetic valve dysfunction (13% versus 1%; p < 0.01), and less frequently annuloaortic ectasia (34% versus 60%; p < 0.001) or aortic dissection (3% versus 26%; p < 0.0001). Concomitant coronary artery bypass grafting or other valve surgery was performed in 30% of patients in both groups. Incidence of early postoperative complications, including bleeding, stroke, renal failure, and respiratory failure, was similar in both groups. Thirty-day mortality was 5.5% in the St. Jude mechanical conduit group and 8.1% in the aortic allograft group (p = 0.4). Unadjusted actuarial survival at 1, 5, and 10 years was 90%, 81%, 67%, and 86%, 70%, 67%, for the St. Jude mechanical conduit and aortic allograft groups, respectively (p = 0.09). Event-free survival at 1 and 5 years was similar for both groups (p = 0.4). By multivariate analysis, New York Heart Association class III or IV, emergently performed aortic root replacement, and postoperative respiratory failure, but not valve conduit type (p = 0.3), were independent predictors of mortality.
  
  
  CONCLUSIONS
  Aortic root replacement can be safely performed with either allograft or mechanical conduits, even in the setting of acute dissection, redo sternotomy, or endocarditis.
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Lima
authors.forename: G Chad
authors.initials: GC
authors.lastname: Hughes
authors.forename: Anthony
authors.initials: A
authors.lastname: Lemaire
authors.forename: James
authors.initials: J
authors.lastname: Jaggers
authors.forename: Donald D
authors.initials: DD
authors.lastname: Glower
authors.forename: Walter G
authors.initials: WG
authors.lastname: Wolfe
mesh_terms: D000328:Adult; D000368:Aged; D001021:Aortic Valve / Q000601:surgery* / Q000637:transplantation; D001705:Bioprosthesis; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014184:Transplantation, Homologous