title: Composite freestyle stentless xenograft with Dacron graft extension for ascending aortic replacement.
abstract: BACKGROUND
  The present study was undertaken to evaluate clinical, hemodynamic, and morphologic results of composite stentless xenograft with polyethylene terephthalate fiber (Dacron; DuPont, Wilmington, DE) graft extension for combined replacement of the aortic valve, root, and ascending aorta.
  
  
  METHODS
  Between 1997 and 2008, 55 consecutive patients (33 men, 71 +/- 11 years) underwent ascending aortic replacement using Medtronic Freestyle with Dacron graft extension (DuPont). Indications included aneurysm (n = 31, 56%), dissection (n = 16, 29%), and endocarditis (n = 8, 15%). Associated procedures were performed in 25 patients (46%). Preoperative logistic EuroSCORE averaged 34% +/- 28%. Mean cardiopulmonary bypass and aortic cross-clamp times were 244 +/- 134 minutes and 162 +/- 69 minutes, respectively.
  
  
  RESULTS
  Clinical follow-up was 100% complete and averaged 2 +/- 3 years. Early mortality was 0% (n = 0) in patients with a preoperative EuroSCORE of less than 20 (n = 26, mean expected mortality, 13% +/- 5%) and 31% (n = 9) in those with preoperative logistic EuroSCORE of at least 20 (n = 29, mean expected mortality, 52% +/- 28%). One- and 3-year survival rates were 83% +/- 5% and 78% +/- 7%, respectively. No major thromboembolic or spontaneous bleeding events were recorded. One patient (2%) required late reoperation for prosthetic valve endocarditis. Echocardiographic follow-up showed no valve dysfunction and low mean transvalvular gradients (7 +/- 5 mm Hg). A 64-channel computed tomographic scan was performed in 33 patients at 32.4 +/- 34 months and revealed two small pseudoaneurysms in a single patient.
  
  
  CONCLUSIONS
  Composite Freestyle with Dacron graft extension appears to be a safe option for bioprosthetic replacement of the aortic root and tubular ascending aorta. However, long-term results using this composite graft will have to be determined.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Albert Chenevier-Henri Mondor, Créteil, France.
authors.forename: Kostantinos
authors.initials: K
authors.lastname: Zannis
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Deux
authors.forename: Boyan
authors.initials: B
authors.lastname: Tzvetkov
authors.forename: Kuniki
authors.initials: K
authors.lastname: Nakashima
authors.forename: Daniel
authors.initials: D
authors.lastname: Loisance
authors.forename: Alain
authors.initials: A
authors.lastname: Rahmouni
authors.forename: Matthias E W
authors.initials: ME
authors.lastname: Kirsch
mesh_terms: D000368:Aged; D001011:Aorta / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D011093:Polyethylene Terephthalates / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D011093:Polyethylene Terephthalates