title: Outcomes of off-pump aortic valve bypass surgery for the relief of aortic stenosis in adults.
abstract: BACKGROUND
  Elderly patients with aortic stenosis presenting for an aortic valve replacement with a hostile ascending aorta remain a challenging patient cohort. The purpose of this study was to assess outcomes after the use of an aortic valve bypass performed without cardiopulmonary bypass.
  
  
  METHODS
  A retrospective review was performed on 21 high-risk patients who underwent primary, isolated aortic valve bypass from September 2004 to June 2009 at Emory Healthcare Hospitals. Aortic valve bypass was used for a porcelain aorta alone in 6 (28.6%) patients, previous coronary artery bypass grafting in 4 (19.0%), or both in 10 (47.6%). One patient (4.8%) was thought not to be a candidate for cardiopulmonary bypass secondary to a severe cirrhosis.
  
  
  RESULTS
  Mean age was 73.9±7.0 years (median, 75.0 years), and 15 patients (71.4%) were male. Mean New York Heart Association classification was 3.0±1.0 (median, 3.0), and preoperative ejection fraction was 0.460±0.163 (median, 0.500). Preoperative comorbidities included peripheral vascular disease (n=10; 47.6%), chronic lung disease (n=16; 76.2%), diabetes mellitus (n=10; 47.6%), and dialysis-dependence (n=2; 9.5%). Either an 18-mm (n=11; 52.4%) or 20-mm (n=10; 47.6%) conduit was used, with an interposed Freestyle 21 porcine root in all patients. All operations were performed without cardiopulmonary bypass. There were no intraoperative mortalities. The mean intensive care unit stay was 133.7±161.3 hours (median, 80.2 hours), and overall postoperative length of stay was 12.9±10.8 days (median, 9.0 days). In-hospital mortality occurred in 3 patients (14.3%). Mid-term follow-up shows an additional 4 patients died at a median follow-up of 1.3 years.
  
  
  CONCLUSIONS
  Aortic valve bypass without cardiopulmonary bypass is a feasible alternative for the treatment of severe aortic stenosis with acceptable short-term morbidity and minimal mortality in this extremely high-risk surgical population.
authors.affiliation: Division of Cardiothoracic Surgery, Joseph B. Whitehead Department of Surgery, Clinical Research Unit, Emory University School of Medicine, Atlanta, Georgia 30308, USA. vthoura@emory.edu
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
authors.forename: W Brent
authors.initials: WB
authors.lastname: Keeling
authors.forename: Robert A
authors.initials: RA
authors.lastname: Guyton
authors.forename: Ameesh
authors.initials: A
authors.lastname: Dara
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Hurst
authors.forename: Omar M
authors.initials: OM
authors.lastname: Lattouf
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D015331:Cohort Studies; D005240:Feasibility Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome