Stentless root bioprosthesis for repair of acute type A aortic dissection.
OBJECTIVE
The superior hemodynamics and excellent long-term clinical performance of stentless xenografts are well described. However, the early and midterm clinical outcomes of stentless valves in patients with acute type A dissection are widely unknown. The current study evaluated the early and midterm clinical outcomes of stentless bioprosthesis for repair of acute type A aortic dissection.


METHODS
Between May 2005 and December 2009, 24 of 80 patients underwent root replacement using the Medtronic Freestyle xenograft (Medtronic Inc, Minneapolis, Minn) at the Meijer Heart Center. Prospective data collection was used for retrospective review. Univariate comparisons of preoperative, intraoperative, and postoperative variables were performed between patients who underwent stentless root bioprosthesis for the correction of acute type A aortic dissection (n = 24).


RESULTS
The mean age of patients was 57 years, with 15 patients aged less than 65 years. Axillary and femoral artery cannulation were used in 16 patients (67%) and 7 patients (29%), respectively. Median crossclamp and cardiopulmonary bypass times were 198 minutes (92-480 minutes) and 288 minutes (109-588 minutes), respectively. Median circulatory arrest time was 28 minutes (24-50 minutes). Operative mortality rate was 25%. Actuarial 5-year survival was 62.5%. No patients required redo aortic root replacement.


CONCLUSIONS
Stentless valve implantation can be accomplished with satisfactory early and midterm clinical outcomes and is a valuable option in patients with acute aortic dissection who require root replacement.
Department of Thoracic and Cardiovascular Surgery, Meijer Heart Center, Butterworth Hospital, Grand Rapids, Mich 49503, USA.
Craig R
CR
Smith
Sotiris C
SC
Stamou
Robert L
RL
Hooker
Charles C
CC
Willekes
John C
JC
Heiser
Lawrence H
LH
Patzelt
Edward T
ET
Murphy
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D002315:Cardiopulmonary Bypass; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D014183:Transplantation, Heterologous; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*