Replacement of the ascending aorta with ‘home-made’ xenopericardial conduit: Mid-term results

Objectives: Composite aortic root replacement with direct coronary artery implantation has been proven to be a safe and durable option for the management of aortic root aneurysm with associated aortic valve involvement. In order to offer selected patients (older than 65 years) the advantage of a tissue valve, we have constructed ‘home-made’ conduits intraoperatively by suturing a stented bovine pericardial valve to a Dacron tube graft due to the lack of a prefabricated biological conduit.

Methods: From September 2002 to June 2006 we replaced the ascending aorta and the aortic valve with a ‘home-made’ conduit in 14 patients. Among those patients, there were 5 females and 9 males with an average age of 75 years (67–82yrs). Associated procedures included coronary artery bypass grafting in four patients, direct closure of an ASD in one patient and cryoablation in one patient.

Results: One patient died in the hospital due to hemorrhagic shock. Late follow up was completed for all surviving patients using multi-slice CT scan and/or echocardiography. The follow-up period ranged from 3 months to 6.5 years during which only one patient died of old age 3yrs. after operation with no signs of a conduit dysfunction. Clinical and instrumental evaluation didn't show any signs of tissue degeneration of the xenopericardial conduit.

Conclusions: An intraoperatively assembled stented biological valve conduit is a safe and effective alternative for composite replacement of the ascending aorta and the aortic valve in a special subset of patients providing at least excellent mid-term results.