title: Long-term follow-up after aortic root replacement with the Shelhigh® biological valved conduit: a word of caution!
abstract: OBJECTIVE
  The aim of this study was to analyse long-term results of aortic root replacement with the Shelhigh® NR-2000C conduit.
  
  
  METHODS
  From January 2001 to October 2005, 63 patients with a median age of 62 years underwent aortic root replacement with a Shelhigh® conduit. Aneurysm (27%), aortic valve endocarditis (30%) and acute type A aortic dissection (33%) were the predominant indications for the surgery. Fifty-four patients (86%) were entered in the follow-up study with the end-points of death, aortic root-related reoperation and endocarditis.
  
  
  RESULTS
  The overall 30-day mortality rate was 8% (n = 5). The median follow-up was 9.5 years (range 0-14.2 years). In total, 13 (24%) deaths occurred during follow-up; of these, 4 were directly conduit-related. The overall estimated survival rates at 1, 5 and 10 years were 85 ± 5, 79 ± 6 and 71 ± 7%, respectively. Reoperation was necessary in 10 (19%) patients due to endocarditis (n = 5), aortic stenosis (n = 3), pseudoaneurysm due to detachment of the right coronary artery (n = 1) and detachment of the non-coronary leaflet (n = 1). The overall estimated rate of freedom from aortic root-related reoperation at 1, 5 and 10 years was 83 ± 5, 79 ± 6 and 64 ± 7%, respectively. Endocarditis of the prosthesis was reported in 9 (17%) patients; of whom, 5 patients required reoperation and 4 were treated medically. In 1 patient with endocarditis, a stroke was reported due to a thromboembolic event.
  
  
  CONCLUSIONS
  The first long-term follow-up after aortic root replacement with the Shelhigh® BioConduit revealed a relatively high rate of death and very high rate of reoperations due to endocarditis, aorto-ventricular disconnection and structural valve failure. This may be potentially connected to the nature of the implanted valved conduit.
authors.affiliation: Division of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Ayhan
authors.initials: A
authors.lastname: Sahin
authors.affiliation: Division of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Müggler
authors.affiliation: Division of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Juri
authors.initials: J
authors.lastname: Sromicki
authors.affiliation: Division of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Etem
authors.initials: E
authors.lastname: Caliskan
authors.affiliation: Division of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Diana
authors.initials: D
authors.lastname: Reser
authors.affiliation: Division of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Maximilian Y
authors.initials: MY
authors.lastname: Emmert
authors.affiliation: Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Hatem
authors.initials: H
authors.lastname: Alkadhi
authors.affiliation: Division of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.affiliation: Division of Cardiovascular Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland tomasholubec@email.cz.
authors.forename: Tomas
authors.initials: T
authors.lastname: Holubec
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome
keywords: Aortic root replacement; Biological valved conduit; Shelhigh prosthesis