title: Longevity after aortic root replacement: is the mechanically valved conduit really the gold standard for quinquagenarians?
abstract: BACKGROUND
  The choice of the best conduit for root/ascending disease and its impact on longevity remain controversial in quinquagenarians.
  
  
  RESULTS
  A total of 205 patients (men=155) between 50 and 60 years (mean, 55.7 ± 2.9 years) received either a stentless porcine xenoroot (n=78) or a mechanically valved composite prosthesis (n=127) between February 1998 and July 2011. Of these, 166 patients underwent root replacement for aneurysmal disease (porcine: 39% [n=65]; mechanical: 61% [n=101]; P=0.5), 25 for acute type A aortic dissection (porcine: 32% [n=8]; mechanical: 68% [n=17]; P=0.51), and 14 for endocarditis/iatrogenic injury involving the aortic root (6.4% [n=5] versus 7.1% [n=9]; P=1.0). The predominant aortic valve pathology was stenosis in 19% (n=38), regurgitation in 50% (n=102), combined valvular dysfunction in 26% (n=54), and normal aortic valve function in 5% (n=11). Concomitant procedures included coronary artery bypass grafting (13%), mitral valve repair (7%), and partial/complete arch replacement (12%/4%), with no significant differences between porcine and mechanical root replacement. Overall hospital mortality was 7.3%, with no difference between the 2 types of valve prostheses (7.7% for porcine and 7.1% for mechanical root replacement; P=1.0). Follow-up averaged 5.4 ± 3.7 years (1096 patient-years) and was 100% complete. Freedom from aorta-related reoperation at 12 years was not statistically different between the groups (porcine: 94.9% versus mechanical: 96.1%; P=0.73). Survival was equivalent between both groups, with a 5-year survival of 86 ± 3% (porcine: 88 ± 4%; mechanical: 85 ± 3%; P=0.96) and a 10-year survival of 76% (porcine: 80 ± 7%; mechanical: 75 ± 5%; P=0.84). The linearized mortality rate was 3.1%/patient-year (porcine: 2.9%/patient-year; mechanical: 3.2%/patient-year).
  
  
  CONCLUSIONS
  In quinquagenerians, long-term survival after stentless porcine xenograft aortic root replacement is equivalent to that after a mechanical Bentall procedure. These results bring into question the predominance of mechanical composite conduits for root replacement in quinquagenerians, particularly in the current era of transcatheter valve-in-valve procedures for structural valve deterioration.
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany.
authors.forename: Christian D
authors.initials: CD
authors.lastname: Etz
authors.forename: Felix F
authors.initials: FF
authors.lastname: Girrbach
authors.forename: Konstantin
authors.initials: K
authors.lastname: von Aspern
authors.forename: Roberto
authors.initials: R
authors.lastname: Battellini
authors.forename: Pascal
authors.initials: P
authors.lastname: Dohmen
authors.forename: Alexandro
authors.initials: A
authors.lastname: Hoyer
authors.forename: Maximilian
authors.initials: M
authors.lastname: Luehr
authors.forename: Martin
authors.initials: M
authors.lastname: Misfeld
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000367:Age Factors; D000818:Animals; D001705:Bioprosthesis / Q000592:standards / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality* / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000592:standards* / Q000639:trends*; D006801:Humans; D008136:Longevity / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013552:Swine
keywords: aneurysm; aorta; aortic valve; surgical procedures