Aortic root replacement using a biovalsalva prosthesis in comparison to a "handsewn" composite bioprosthesis.
BACKGROUND
The Biovalsalva aortic root prosthesis incorporates an Elan porcine stentless biological aortic valve suspended within a triple-layered vascular conduit with preformed aortic sinuses of Valsalva. This study compared implantation of the Biovalsalva prosthesis with a "handsewn" composite bioprosthetic graft (CE Perimount bovine bioprosthesis anastomosed to a gelatin-impregnated gelweave Dacron graft).


METHODS
Between December 2004 and January 2009, 39 patients underwent elective or urgent aortic root replacement (modified Bentall procedure with coronary button reimplantation) using a Biovalsalva (n = 21) or a handsewn bioprosthesis (n = 18) for aortic root dilatation.


RESULTS
There was no significant difference in the preoperative variables between the two study groups including age (70.7 +/- 1.7 vs. 67.6 +/- 2.9 years, p > 0.05). There was no in-hospital mortality. Three patients in each group underwent concomitant aortic hemi-arch replacement. Patients who underwent Biovalsalva implantation had a reduced need for transfusion of blood (1.25 +/- 0.32 vs. 3.17 +/- 0.71 units, p < 0.05) and fresh frozen plasma (2.78 +/- 0.39 vs. 1.85 +/- 0.31, p < 0.05), and reduced mediastinal blood loss (416 +/- 52 vs. 583 +/- 74 mL, p < 0.05) compared to those with a handsewn bioprosthesis. Cardiopulmonary bypass time (141 +/- 6 vs. 170 +/- 17 minutes, p = NS) and aortic cross-clamp time (113 +/- 6 vs. 115 +/- 7 minutes, p = NS) were similar. Postoperative echocardiography demonstrated excellent hemodynamic function of the Biovalsalva prosthesis (mean size 25.1 +/- 0.4 mm valved conduit) with a peak pressure gradient of 26.2 +/- 1.9 mmHg and no or trivial valvular regurgitation.


CONCLUSIONS
The Biovalsalva prosthesis should be considered for patients requiring a biological aortic root replacement. It offers an "off-the-shelf" preassembled composite biological valve conduit with excellent hemostatic and hemodynamic properties.
Moorjani
Narain
N
Wessex Cardiothoracic Centre, Southampton General Hospital, Southampton, United Kingdom. narain.moorjani@doctors.org.uk
Modi
Amit
A
Mattam
Kavita
K
Barlow
Clifford
C
Tsang
Geoffrey
G
Haw
Marcus
M
Livesey
Steven
S
Ohri
Sunil
S
D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000706:statistics & numerical data; D004452:Echocardiography; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008482:Mediastinum / Q000601:surgery; D019990:Perioperative Care; D012189:Retrospective Studies; D012850:Sinus of Valsalva / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom