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Ann Thorac Surg 2002;74:S1769-S1772
© 2002 The Society of Thoracic Surgeons
a department of Cardiothoracic Surgery, Mount Sinai Medical Center, New York, New York, USA
b Biomathematical Sciences, Mount Sinai Medical Center, New York, New York, USA
c Department of Englewood Cardiac Center, Englewood Hospital, Englewood, New Jersey, USA
* Address reprint requests to Dr Galla, Department of Cardiothoracic Surgery, Box 1028, Mount Sinai Medical Center, New York, NY, 10029, USA.
e-mail: jan.galla{at}mssm.edu
Presented at the Aortic Surgery Symposium VIII, May 2–3, 2002, New York, NY.
Abstract
BACKGROUND: Patients requiring aortic root reconstruction who are deemed unable to take anticoagulants offer unique challenges to the surgeon. For these patients, we have been manufacturing composite conduits intraoperatively using stented bioprostheses.
METHODS: During the 10-year period from April 1992 until May 2002, 141 patients (105 male, 36 female) from 34 to 88 years of age underwent aortic root reconstruction with biological valved conduits. Diagnoses included dissection (n = 28, 9 acute type A), degenerative (64), atherosclerotic (32), anuloaortic ectasia (9), endocarditis (5), and other causes (3). Preoperative risk factors included hypertension (90), smoking (63), coronary artery disease (48), and diabetes (6). Valved conduits were mainly constructed from pericardial valves and impregnated Dacron grafts. Distal anastomosis was performed open in all cases except 6; the ascending aorta only was replaced in 63 patients, a hemiarch reconstruction was used in 71, and more extensive arch reconstruction in 7. Additional cardiac procedures were performed in 59 patients.
RESULTS: Two deaths occurred in the operating room (biventricular failure). Late hospital mortality was 11 of 141 (7.8%) of which 6 (55%) were cardiac, 2 (18.2%) were infectious, 2 (18.2%) were of other complications and 1 (9.1%) was unknown. Three patients (2.1%) sustained permanent and 3 transient strokes. No structural deterioration of the valve and an approximately 86% freedom from thromboembolic events was observed during 5 years.
CONCLUSIONS: For patients for whom anticoagulation is contraindicated or undesirable, reconstruction of the aortic root with a stented bioprosthetic valved conduit offers an acceptable alternative to mechanical prostheses.
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