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Original Articles: Adult Cardiac

Composite Freestyle Stentless Xenograft With Dacron Graft Extension for Ascending Aortic Replacement

^a Department of Thoracic and Cardiovascular Surgery, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Albert Chenevier-Henri Mondor, Créteil, France
^b Department of Radiology, Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Albert Chenevier-Henri Mondor, Créteil, France

Accepted for publication March 25, 2009.

^_* Address correspondence to Dr Kirsch, AP-HP, Groupe hospitalo-universitaire Albert Chenevier–Henri Mondor, 51, avenue du Maréchal de Lattre de Tassigny, Créteil Cédex, 94 000, France (Email: matthias.kirsch{at}hmn.aphp.fr).

Background: The present study was undertaken to evaluate clinical, hemodynamic, and morphologic results of composite stentless xenograft with polyethylene terephthalate fiber (Dacron; DuPont, Wilmington, DE) graft extension for combined replacement of the aortic valve, root, and ascending aorta.

Methods: Between 1997 and 2008, 55 consecutive patients (33 men, 71 ± 11 years) underwent ascending aortic replacement using Medtronic Freestyle with Dacron graft extension (DuPont). Indications included aneurysm (n = 31, 56%), dissection (n = 16, 29%), and endocarditis (n = 8, 15%). Associated procedures were performed in 25 patients (46%). Preoperative logistic EuroSCORE averaged 34% ± 28%. Mean cardiopulmonary bypass and aortic cross-clamp times were 244 ± 134 minutes and 162 ± 69 minutes, respectively.

Results: Clinical follow-up was 100% complete and averaged 2 ± 3 years. Early mortality was 0% (n = 0) in patients with a preoperative EuroSCORE of less than 20 (n = 26, mean expected mortality, 13% ± 5%) and 31% (n = 9) in those with preoperative logistic EuroSCORE of at least 20 (n = 29, mean expected mortality, 52% ± 28%). One- and 3-year survival rates were 83% ± 5% and 78% ± 7%, respectively. No major thromboembolic or spontaneous bleeding events were recorded. One patient (2%) required late reoperation for prosthetic valve endocarditis. Echocardiographic follow-up showed no valve dysfunction and low mean transvalvular gradients (7 ± 5 mm Hg). A 64-channel computed tomographic scan was performed in 33 patients at 32.4 ± 34 months and revealed two small pseudoaneurysms in a single patient.

Conclusions: Composite Freestyle with Dacron graft extension appears to be a safe option for bioprosthetic replacement of the aortic root and tubular ascending aorta. However, long-term results using this composite graft will have to be determined.