Ann Thorac Surg 2004;78:2153
© 2004 The Society of Thoracic Surgeons
New technology
INVITED COMMENTARY
Rainald Seitelberger, MD,
Ernst Wolner, MD
Department of Cardiothoracic Surgery, University of Vienna, Waehringerguertel 18–20, A-1090 Vienna, Austria
seitel{at}magnet.at
ernst.wolner{at}akh-wien.ac.at
The paper describes and discusses the use of an extended root stentless xenograft (Medtronic Freestyle) for the combined replacement of the aortic valve and the ascending aorta in six patients. The authors have extended experience with various methods of aortic root replacement, including Ross procedures, homografts, and stentless conduits. In comparison to the regular Freestyle stentless conduits, the extended conduits are supplied on a case-by-case basis for selected patients and are characterized by a 2 cm extension of the harvested ascending aorta. The authors report that this extension of the conduit was sufficient to replace the entire ascending aorta, and prevented the need of adding a prosthetic graft to the stentless root in cases of an ectatic and/or aneurysmal ascending aorta.
Although the extended Freestyle conduit is certainly helpful in some cases, there are issues, however, that in our opinion limit its use to selected patients that are carefully evaluated. First, the company does not plan to market these conduits due to constraints imposed by costs, harvesting, and handling. Consequently, the conduits have to be ordered at least 6 to 8 weeks in advance, which limits their potential use to only a few patients.
In addition, we do not completely agree with the authors that the additional 2 cm of conduit length is sufficient to replace any type of ascending aortic ectasia/aneurysm. We also used the extended version of the Freestyle prosthesis in two patients with similiar indications. Both patients had ascending aortic aneurysms more than 6 cm and extended to the aortic arch in one patient. In this patient, the additional 2 cm length of the extended Freestyle conduit was too short to replace the entire length of the aneurysm and an additional segment of a prosthetic graft was required. From this experience we concluded that the extended version should only be used in patients with aortic ectasia/aneurysm of limited length; this precision is sometimes difficult to determine during preoperative evaluation.
Finally, the issue of significant aortic wall calcification in Freestyle conduits, which leads to subsequent potential problems during reoperation, is still unresolved and can only be assessed in the future. In conclusion, the authors have to be congratulated for reporting and discussing their satisfying experience with the extended Freestyle stentless prosthesis. The use of this conduit, however, is certainly limited due to the various constraints we have mentioned above.
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Footnotes
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The Society of Thoracic Surgeons, the Southern Thoracic Surgical Association, and The Annals of Thoracic Surgery neither endorse nor discourage use of the new technology described in this article.
Related Article
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Replacement of the Aortic Valve and Ascending Aorta With an Extended Root Stentless Xenograft
- Wolfgang B. Hemmer, Cornelius A. Botha, Jürgen O. Böhm, Tobias Herrmann, Christoph Starck, and Joachim-Gerd Rein
Ann. Thorac. Surg. 2004 78: 2150-2152.
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