title: Comparing aortic root replacements: porcine bioroots versus pericardial versus mechanical composite roots: hemodynamic and ventricular remodeling at greater than one-year follow-up.
abstract: BACKGROUND
  Stentless porcine bioroots and pericardial composite roots were developed as prostheses that avoid the anticoagulation necessary for mechanical composite roots. Data on the hemodynamics of all root replacements are lacking and questions remain regarding comparative performance.
  
  
  METHODS
  This study evaluated patients receiving a stentless porcine bioroot, a pericardial, or a mechanical composite root at a single institution from January 2000 to December 2008. All patients underwent preoperative, postoperative and greater than 1-year echocardiograms. All root replacements were performed for aortic insufficiency or aneurysm. Median follow-up was 3.3 years (1 to 8 years).
  
  
  RESULTS
  There were no significant differences in preoperative left ventricular ejection fraction, aortic valve peak gradient, mean gradient, left ventricular end diastolic diameter, and left ventricular end systolic diameter. Postoperative peak and mean gradients in mechanical composite roots were significantly higher than stentless porcine bioroots. At greater than 1 year, stentless porcine bioroots had significantly lower peak and mean gradients than both mechanical composite roots and pericardial composite roots. The end diastolic diameter was also significantly smaller in stentless porcine bioroots at greater than 1 year than mechanical composite roots.
  
  
  CONCLUSIONS
  All prostheses resulted in favorable hemodynamic and ventricular remodeling. Stentless porcine bioroots had the lowest gradients at greater than 1 year of all root replacements, with significantly better ventricular remodeling when compared with mechanical composite roots. Pericardial roots also had favorable hemodynamics and ventricular remodeling, suggesting that they are a viable alternative.
authors.affiliation: Department of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. fenton.mccarthy@uphs.upenn.edu
authors.forename: Fenton H
authors.initials: FH
authors.lastname: McCarthy
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
authors.forename: Alberto
authors.initials: A
authors.lastname: Pochettino
authors.forename: Zachary
authors.initials: Z
authors.lastname: Fox
authors.forename: Patrick
authors.initials: P
authors.lastname: Moeller
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.forename: Nimesh D
authors.initials: ND
authors.lastname: Desai
mesh_terms: D000818:Animals; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000601:surgery*; D011474:Prosthesis Design; D012189:Retrospective Studies; D013552:Swine; D013997:Time Factors; D016896:Treatment Outcome; D020257:Ventricular Remodeling / Q000502:physiology*