Aortic root replacement with stentless porcine xenografts: early and late outcomes in 132 patients.
BACKGROUND
Traditionally, aortic root replacement has most commonly involved mechanical composite valve grafts, which have excellent durability but necessitate lifelong anticoagulation. Stentless porcine xenografts (bioroots) are a recently developed alternative that enable root replacement without the necessity of long-term anticoagulation. This study examined the early and late outcomes of aortic root replacement with porcine bioroots.


METHODS
Porcine bioroots were used for root replacement in 132 patients. Of these, 129 (97.7%) required graft extensions for ascending aortic replacement, and 55 (41.7%) underwent aortic arch replacement. Twenty-three operations (17.4%) were reoperations. Twenty-four patients (18.2%) had aortic dissection. Early and late outcomes were ascertained by reviewing medical records. Changes in New York Heart Association (NYHA) class were used to assess improvements in functional status. Follow-up echocardiography results were reviewed to assess bioprosthetic valve function and changes in left ventricular ejection fraction.


RESULTS
There were 10 operative deaths (7.6%), 9 of which were directly related to intraoperative ventricular failure. Nine patients (6.8%) had late valve-related complications, including 5 patients with prosthetic endocarditis (3 died), 1 annular pseudoaneurysm, and 3 sudden, unexplained deaths. Survivors' NYHA status and left ventricular ejection fraction improved significantly. No structural valve dysfunction was evident during follow-up. Actuarial survival was 85.6% +/- 3.1% at 1 year and 77.8% +/- 4.8% at 5 years.


CONCLUSIONS
Aortic root replacement with porcine xenografts can be performed with respectable early and late outcomes, even when combined with aortic arch replacement. Further follow-up is necessary to evaluate long-term bioroot durability.
LeMaire
Scott A
SA
The Texas Heart Institute at St. Luke's Episcopal Hospital, and the Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA. slemaire@bcm.edu.
Green
Susan Y
SY
Sharma
Kapil
K
Cheung
Catherine K
CK
Sameri
Aryan
A
Tsai
Peter I
PI
Adams
Gerald
G
Coselli
Joseph S
JS
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D000818:Animals; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011336:Probability; D011379:Prognosis; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011859:Radiography; D012086:Reoperation; D018570:Risk Assessment; D015996:Survival Rate; D013552:Swine; D014183:Transplantation, Heterologous / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult