ATS
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Christos Alexiou
Marek J. Jasinski
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Akar, A. R.
Right arrow Articles by Sosnowski, A. W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Akar, A. R.
Right arrow Articles by Sosnowski, A. W.
Related Collections
Right arrow Valve disease

Ann Thorac Surg 2002;74:1450-1457
© 2002 The Society of Thoracic Surgeons

Original article: cardiovascular

Use of stentless xenografts in the aortic position: determinants of early and late outcome

A. Ruchan Akar, MDa, b, Adam Szafranek, MDa, b, Christos Alexiou, FRCSa, b, Robert Janas, MDa, b, Marek J. Jasinski, MDa, b, Justiaan Swanevelder, FRCAa, b, Andrzej W. Sosnowski, FRCSa, b*

a Department of Cardiothoracic Surgery, University Hospitals of Leicester, Glenfield Hospital, Leicester, United Kingdom
b Department of Anesthesiology, University Hospitals of Leicester, Glenfield Hospital, Leicester, United Kingdom

Accepted for publication June 5, 2002.

* Address reprint requests to Dr. Sosnowski, Department of Cardiothoracic Surgery, Glenfield Hospital, Groby Rd, Leicester, LE3 9QP, UK.
e-mail: kardio{at}stayfree.co.uk

Background. Whether to perform a stentless aortic valve replacement (AVR) is not well established. Our aim was to determine the outcome after AVR with stentless xenograft valves.

Methods. Between 1996 and 2001, a total of 404 patients (mean age 70.4 years) underwent a stentless AVR by one surgeon in our unit. Concomitant procedures were performed in 132 patients (33%). Twenty patients (6.4%) had undergone previous AVR. Eleven types of stentless xenograft valves were implanted: Medtronic Freestyle in 221 patients (55%), Shelhigh in 55 (14%), Shelhigh composite conduit in 33 (8%), Sorin in 26 (6%), Cryolife O‘Brien in 25 (6%), Aortech-Elan in 17 (4%), Edwards Prima in 14 (4%), Toronto SPV in 7 (2%), and other valves in 6 (1%). A subcoronary implantation technique was used in 302 cases (76%), complete root replacement in 62 (15%), and a modified Bentall-De Bono procedure in 33 (8%). Mean follow-up was 19.4 months (range, 1.2 to 60.6 months).

Results. Overall hospital mortality was 4.2%. This was 2.4% for isolated AVR, 3.6% for AVR and coronary artery bypass grafting, 5.5% for replacement of two or more valves, and 12% for the modified Bentall procedure. On multiple logistic regression redo cardiac operation (p = 0.0006), cardiogenic shock (p = 0.001), left ventricular ejection fraction less than 0.30 (p = 0.01), modified Bentall procedure (p = 0.03), and endocarditis (p = 0.04) were predictors of in-hospital death. Five-year freedom from thromboembolism, hemorrhage, prosthetic endocarditis, structural valve deterioration, and reoperation was 97%, 99%, 99%, 98%, and 96%, respectively. Kaplan-Meier survival at 5 years was 88%. On Cox regression, cardiogenic shock (p = 0.001) and older age (p = 0.03) were adverse predictors of survival. At echocardiographic examination within 6 months from the operation, mean aortic valve gradients were 15 ± 6 mm Hg, 12.8 ± 3 mm Hg, 10.8 ± 4 mm Hg, 9.3 ± 3 mm Hg, 9.1 ± 4 mm Hg, and 8.2 ± 3 mm Hg for valve sizes of 19, 21, 23, 25, 27, and 29 mm, respectively.

Conclusions. The availability of several stentless valve designs facilitates the surgical treatment of diverse aortic valve or root diseases with encouraging early and midterm results. Patients requiring concomitant procedures may also benefit from the excellent hemodynamic characteristics of a stentless valve. We consider stentless AVR the treatment of choice for patients older than 60 years and those having small aortic roots.




This article has been cited by other articles:


Home page
 Ann. Thorac. Surg.Home page
S. A. LeMaire, S. Y. Green, K. Sharma, C. K. Cheung, A. Sameri, P. I. Tsai, G. Adams, and J. S. Coselli
Aortic root replacement with stentless porcine xenografts: early and late outcomes in 132 patients.
Ann. Thorac. Surg., February 1, 2009; 87(2): 503 - 513.
[Abstract] [Full Text] [PDF]

Home page
 ICVTSHome page
K. Bochenek-Klimczyk, K. K.W. Lau, M. Galinanes, and A. W. Sosnowski
Preassembled stentless valved-conduit for the replacement of the ascending aorta and aortic root
Interactive CardioVascular and Thoracic Surgery, December 1, 2008; 7(6): 964 - 968.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
M. Musci, H. Siniawski, M. Pasic, Y. Weng, A. Loforte, S. Kosky, C. Yankah, and R. Hetzer
Surgical therapy in patients with active infective endocarditis: seven-year single centre experience in a subgroup of 255 patients treated with the Shelhigh(R) stentless bioprosthesis
Eur. J. Cardiothorac. Surg., August 1, 2008; 34(2): 410 - 417.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
T. P. Carrel, F. S. Schoenhoff, J. Schmidli, M. Stalder, F. S. Eckstein, and L. Englberger
Deleterious outcome of No-React-treated stentless valved conduits after aortic root replacement: Why were Warnings ignored?
J. Thorac. Cardiovasc. Surg., July 1, 2008; 136(1): 52 - 57.
[Abstract] [Full Text] [PDF]

Home page
 Ann. Thorac. Surg.Home page
K. K.W. Lau, K. Bochenek-Klimczyk, M. Galinanes, and A. W. Sosnowski
Replacement of the Ascending Aorta, Aortic Root, and Valve with a Novel Stentless Valved Conduit
Ann. Thorac. Surg., July 1, 2008; 86(1): 278 - 281.
[Abstract] [Full Text] [PDF]

Home page
 Card Surg AdultHome page
P. Stelzer
Stentless Aortic Valve Replacement: Porcine and Pericardial
Card. Surg. Adult, January 1, 2008; 3(2008): 915 - 934.
[Full Text]

Home page
 Eur J EchocardiogrHome page
D. Poppe, P. Blank, U. Boge, T. Kolzow, J. Loh, and B. Schwaab
Extensive dehiscence of a stentless bioprosthesis with only mild paravalvular regurgitation after replacement of a degenerated bicuspid aortic valve
Eur J Echocardiogr, January 1, 2008; 9(1): 88 - 91.
[Abstract] [Full Text] [PDF]

Home page
 CirculationHome page
D. Pavoni, L. P. Badano, F. Ius, E. Mazzaro, R. Frassani, S. Gelsomino, and U. Livi
Limited Long-Term Durability of the Cryolife O'Brien Stentless Porcine Xenograft Valve
Circulation, September 11, 2007; 116(11_suppl): I-307 - I-313.
[Abstract] [Full Text] [PDF]

Home page
 J. Thorac. Cardiovasc. Surg.Home page
P. Totaro, N. Degno, A. Zaidi, A. Youhana, and V. Argano
Carpentier-Edwards PERIMOUNT Magna bioprosthesis: A stented valve with stentless performance?
J. Thorac. Cardiovasc. Surg., December 1, 2005; 130(6): 1668 - 1674.
[Abstract] [Full Text] [PDF]

Home page
 ICVTSHome page
U. Ozyurda, A. R. Akar, O. Uymaz, M. Oguz, M. Ozkan, C. Yildirim, A. Aslan, and R. Tasoz
Early clinical experience with the On-X prosthetic heart valve
Interactive CardioVascular and Thoracic Surgery, December 1, 2005; 4(6): 588 - 594.
[Abstract] [Full Text] [PDF]

Home page
 Eur. J. Cardiothorac. Surg.Home page
J. A. Carr and E. B. Savage
Aortic valve repair for aortic insufficiency in adults: a contemporary review and comparison with replacement techniques
Eur. J. Cardiothorac. Surg., January 1, 2004; 25(1): 6 - 15.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2002 by The Society of Thoracic Surgeons.