title: Mid-term results of aortic root replacement using a self-assembled biological composite graft.
abstract: OBJECTIVE
  To report the mid-term results of aortic root replacement using a self-assembled biological composite graft, consisting of a vascular tube graft and a stented tissue valve.
  
  
  METHODS
  Between January 2005 and December 2011, 201 consecutive patients [median age 66 (interquartile range, IQR, 55-77) years, 31 female patients (15.4%), median logistic EuroSCORE 10 (IQR 6.8-23.2)] underwent aortic root replacement using a stented tissue valve for the following indications: annulo-aortic ectasia or ascending aortic aneurysm with aortic valve disease in 162 (76.8%) patients, active infective endocarditis in 18 (9.0%) and acute aortic dissection Stanford type A in 21 (10.4%). All patients underwent clinical and echocardiographic follow-up. We analysed survival and valve-related events.
  
  
  RESULTS
  The overall in-hospital mortality rate was 4.5%. One- and 5-year cardiac-related mortality rates were 3 and 6%, and overall survival was 95 ± 1.5 and 75 ± 3.6%, respectively. The rate of freedom from structural valve failure was 99% and 97 ± 0.4% at the 1- and 5-year follow-up, respectively. The incidence rates of prosthetic valve endocarditis were 3 and 4%, respectively. During a median follow-up of 28 (IQR 14-51) months, only 2 (1%) patients required valve-related redo surgery due to prosthetic valvular endocarditis and none suffered from thromboembolic events. One percent of patients showed structural valve deterioration without any clinical symptoms; none of the patients suffered greater than mild aortic regurgitation.
  
  
  CONCLUSIONS
  Aortic root replacement using a self-assembled biological composite graft is an interesting option. Haemodynamic results are excellent, with freedom from structured valve failure. Need for reoperation is extremely low, but long-term results are necessary to prove the durability of this concept.
authors.affiliation: Department for Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland Department for General Surgery, Medical University of Graz, Graz, Austria.
authors.forename: Katharina
authors.initials: K
authors.lastname: Meszaros
authors.affiliation: Department for Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland.
authors.forename: Sophia
authors.initials: S
authors.lastname: Liniger
authors.affiliation: Department for Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland.
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
authors.affiliation: Department for Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland.
authors.forename: Olaf
authors.initials: O
authors.lastname: Stanger
authors.affiliation: Department for Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland.
authors.forename: David
authors.initials: D
authors.lastname: Reineke
authors.affiliation: Department for Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland.
authors.forename: Lars
authors.initials: L
authors.lastname: Englberger
authors.affiliation: Department for Cardiovascular Surgery, University Hospital Berne, Berne, Switzerland thierry.carrel@insel.ch.
authors.forename: Thierry P
authors.initials: TP
authors.lastname: Carrel
mesh_terms: D000368:Aged; D001011:Aorta / Q000503:physiopathology / Q000601:surgery*; D001018:Aortic Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D018572:Disease-Free Survival; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aortic root replacement; Biological valve; Echocardiography; Results