Subscribe to RSS
DOI: 10.1055/s-2001-19014
© Georg Thieme Verlag Stuttgart · New York
Aortic Valve Replacement with a Stentless Bioprosthesis
using the Full-Root Technique[∗]
Publication History
Publication Date:
17 December 2001 (online)
Background: In aortic valve replacement stentless bioprostheses results in improved hemodynamic function compared to stented valves. Using the root replacement technique even larger prostheses are implantable. We present our experience with stentless bioprostheses implanted in the “full-root” technique. Patients and Methods: Between 01/1997 and 12/2000, 149 patients underwent root replacement with a stentless xenograft (age 70 ± 9y, women 52 %, ejection-fraction 58 ± 15 %). Isolated stenosis was present in 34 %, incompetence in 24 %, and mixed disease in 42 % of patients. Bacterial endocarditis was found in 16 %, and 3 patients suffered from acute aortic dissection. Results: Mean bypass time was 118 ± 45 min, ischemic time 83 ± 26 min and operating time 201 ± 62 min. Concomitant procedures were CABG (32 %), replacement of ascending aorta (22 %) and aortic arch (13 %), mitral valve repair (6.7 %), and carotid thrombendarterectomy (1.3 %). Total in-hospital mortality was 6.7 %, with a 1.8 % mortality rate for patients with isolated aortic valve disease. Conclusion: Aortic valve replacement using stentless bioprostheses in the root replacement technique is a safe surgical option. In patients with small aortic roots or ring abscesses it guarantees remodelling of the aortic annulus.
Key words:
Aortic valve replacement - Stentless bioprostheses - Root replacement - Endocarditis - Aortic dissection
1 Presented at the 30th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery
References
- 1 American College of Cardiology . Guidelines for the management of patients with valvular heart disease. J Heart Valve Dis. 1998; 7 672-707
- 2 David T E, Feindel C M, Scully H E, Bos J, Rakowski H. Aortic valve replacement with stentless porcine aortic valves: a ten-year experience. J Heart Valve Dis. 1998; 7 250-254
- 3 Jin X Y, Pillai R, Westaby S. Medium-term determinants of left ventricular mass index after stentless aortic valve replacement. Ann Thorac Surg. 1999; 67 411-416
- 4 Kon N D, Westaby S, Amarasena N, Pillai R, Cordell A R. Comparison of implantation techniques using freestyle stentless porcine aortic valve. Ann Thorac Surg. 1995; 59 857-862
- 5 Fries R, Wendler O, Schieffer H, Schäfers H J. Comparative rest and exercise hemodynamics of 23-mm stentless versus 23-mm stented aortic bioprosthesis. Ann Thorac Surg. 2000; 69 817-822
- 6 Gontijo B F, Vrandecic M, Fantini F A, Oliveira M HC, Avelar S OS. Porcine stentless aortic valve re-replacements and acute aortic valve endocarditis. J Heart Valve Dis. 1995; 4 171-175
- 7 Schäfers H J, Fries R, Langer F, Nikoloudakis N, Graeter T, Grundmann U. Valve-preserving replacement of the ascending aorta: remodeling versus reimplantation. J Thorac Cardiovasc Surg. 1998; 116 990-996
- 8 Hvass U, Palatianos G M, Frassani R, Puricelli C, O’Brien M. Multicenter study of stentless valve replacement in the small aortic root. J Thorac Cardiovasc Surg. 1999; 117 267-272
- 9 Vrandecic M, Fantini F A, Filho B G. et al . Retrospective clinical analysis of stented vs. stentless porcine aortic bioprosthesis. Eur J Cardiothorac Surg. 2000; 18 46-53
- 10 Transley P D, Sheppard M N, Pepper J. Symptomatic calcific stenosis of a Toronto stentless porcine valve. Eur J Cardiothorac Surg. 2000; 17 763-765
- 11 Jin X Y, Westaby S. Aortic root geometry and stentless porcine valve competence. Semin Thorac Cardiovasc Surg. 1999; 11 (suppl 1) 145-150
- 12 Van Nooten G, Ozaki S, Herijgers P, Segers O, Verdonck P, Flameng W. Distorsion of the stentless porcine valve induces accelerated leaflet fibrosis and calcification in juvenile sheep. J Heart Valve Dis. 1999; 8 34-41
- 13 Luciani G B, Casali G, Mazzucco A. Risk factors for coronary complications after stentless aortic root replacement. Semin Thorac Cardiovasc Surg. 1999; 11 (suppl 1) 126-132
- 14 Santini F, Musazzi A, Bertolini P. et al . Stentless porcine bioprostheses in the treatment of aortic valve infective endocarditis. J Card Surg. 1995; 10 205-209
- 15 Sakaguchi T, Sawa Y, Ohtake S, Hirata N, Matsuda H. The freestyle stentless bioprosthesis for prosthetic valve endocarditis. Ann Thorac Surg. 1999; 67 533-534
- 16 Tseng E E, Lee C A, Cameron D E. et al . Aortic valve replacement in the elderly. Risk factors and long-term results. Ann Thorac Surg. 1997; 225 793-802
- 17 Luciani G B, Bertolini P, Vecchi B, Mazzucco A. Midterm results after aortic valve replacement with freehand stentless xenografts: a comparison of three prostheses. J Thorac Cardiovasc Surg. 1998; 115 1287-1297
- 18 Siebenmann R P. Implantation of the Toronto SPV stentless porcine bioprosthesis in dilated ascending aorta. Ann Thorac Surg. 1997; 64 1197-1200
1 Presented at the 30th Annual Meeting of the German Society for Thoracic and Cardiovascular Surgery
Dr. med. Olaf Wendler
Klinik für Thorax- und Herz-Gefäßchirurgie
Universitätskliniken des Saarlandes
Kirrberger Straße 1
66421 Homburg/Saar
Germany
Phone: 06841-1622501
Fax: 06841-1622788
Email: chowen@med-rz.uni-sb.de