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Ann Thorac Surg 2004;78:385
© 2004 The Society of Thoracic Surgeons

Correspondence

Aortic valved conduit with a stented xenograft

Paul P. Urbanski, MD

Herz- and Gefaess-Klinik, Salzburger Leite 1, 97616 Bad Neustadt, Germany

e-mail: p.urbanski{at}herzchirurgie.de

To the Editor:

I read with great interest the article by Hilgenberg and Mora [1] on an aortic composite graft with a stented biological valve prosthesis. The surgical technique described is based on the principle of intraoperative assembly of a composite graft made of a collagen-coated vascular prosthesis and a biological valve prosthesis. Since 1998, my colleagues and I [2, 3] have implanted such composite grafts as a standard procedure, although we use stentless aortic valve prostheses. One reason for a stentless prosthesis is that in the case of structural valvular deterioration, it theoretically would be possible to replace the incorporated valve prosthesis while leaving the tube graft untouched. Even if the stentless valve prosthesis could not be removed in toto, valve replacement within the conduit would be possible after excision of the valve cusps.

Replacement of a degenerated stented valve prosthesis within the conduit, however, seems quite problematic. Therefore, patients with a high probability of reoperation because of life expectancy can undergo operation for placement of a stented biological prosthesis as follows: The aortic valve is excised, and the ascending aorta is completely resected leaving approximately 3 mm of aortic wall from the leaflets and the commissures. The coronary ostia are excised with buttons of surrounding aortic wall. Replacement of the ascending aorta with a Dracon prosthesis can be done with the technique of Sarsam and Yacoub [4] of David and Feindel [5] depending on surgeon's preference. Without the necessity for a functional valve reconstruction, this procedure should not constitute a special challenge for the experienced surgeon. The next step is the implantation of a stented valve prosthesis at the annulus with the supraannular suture technique. Finally, the coronary arteries are implanted in the conduit using the button technique. In the case of structural deterioration of the stented valve prosthesis, it can be replaced relatively easily and even repeatedly through a transverse incision in the graft, as there is no contact between the conduit and the suture ring of the valve prosthesis.

The additional effort during primary replacement of the aortic valve and the ascending aorta will always be rewarded in patients with a high probability of reoperation because of life expectancy. The surgeon who will be able to do an easier valve prosthesis re-replacement as well as the patient who will have a lower risk during reoperation will be grateful.

References

  1. Hilgenberg A.D., Mora B.N. Composite aortic root replacement with a bovine pericardial valve conduit. Ann Thorac Surg 2003;75:1338-1339.[Abstract/Free Full Text]
  2. Urbanski P.P. Replacement of the ascending aorta and aortic valve with a valved stentless composite graft. Ann Thorac Surg 1999;67:1501-1502.[Abstract/Free Full Text]
  3. Urbanski P.P., Diegeler A., Siebel A., Zacher M., Hacker R.W. Valved stentless composite graft: clinical outcomes and hemodynamic characteristics. Ann Thorac Surg 2003;75:467-471.[Abstract/Free Full Text]
  4. Sarsam M.A.I., Yacoub M. Remodeling of the aortic valve annulus. J Thorac Cardiovasc Surg 1993;105:435-438.[Abstract]
  5. David T.E., Feindel C.M. An aortic valve–sparing operation for patients with aortic incompetence and aneurysm of the ascending aorta. J Thorac Cardiovasc Surg 1992;103:617-621.[Abstract]




This Article
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