Premium
Aortic Root Replacement Using a Biovalsalva Prosthesis in Comparison to a “Handsewn” Composite Bioprosthesis
Author(s) -
Moorjani Narain,
Modi Amit,
Mattam Kavita,
Barlow Clifford,
Tsang Geoffrey,
Haw Marcus,
Livesey Steven,
Ohri Sunil
Publication year - 2010
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.2010.01015.x
Subject(s) - medicine , prosthesis , aortic root , surgery , bentall procedure , aortic cross clamp , aortic valve replacement , aortic valve , hemodynamics , cardiac skeleton , cardiology , aorta , cardiac surgery , stenosis
Background: The Biovalsalva aortic root prosthesis incorporates an Elan porcine stentless biological aortic valve suspended within a triple‐layered vascular conduit with preformed aortic sinuses of Valsalva. This study compared implantation of the Biovalsalva prosthesis with a “handsewn” composite bioprosthetic graft (CE Perimount bovine bioprosthesis anastomosed to a gelatin‐impregnated gelweave Dacron graft). Methods: Between December 2004 and January 2009, 39 patients underwent elective or urgent aortic root replacement (modified Bentall procedure with coronary button reimplantation) using a Biovalsalva (n = 21) or a handsewn bioprosthesis (n = 18) for aortic root dilatation. Results: There was no significant difference in the preoperative variables between the two study groups including age (70.7 ± 1.7 vs. 67.6 ± 2.9 years, p > 0.05). There was no in‐hospital mortality. Three patients in each group underwent concomitant aortic hemi‐arch replacement. Patients who underwent Biovalsalva implantation had a reduced need for transfusion of blood (1.25 ± 0.32 vs. 3.17 ± 0.71 units, p < 0.05) and fresh frozen plasma (2.78 ± 0.39 vs. 1.85 ± 0.31, p < 0.05), and reduced mediastinal blood loss (416 ± 52 vs. 583 ± 74 mL, p < 0.05) compared to those with a handsewn bioprosthesis. Cardiopulmonary bypass time (141 ± 6 vs. 170 ± 17 minutes, p = NS) and aortic cross‐clamp time (113 ± 6 vs. 115 ± 7 minutes, p = NS) were similar. Postoperative echocardiography demonstrated excellent hemodynamic function of the Biovalsalva prosthesis (mean size 25.1 ± 0.4 mm valved conduit) with a peak pressure gradient of 26.2 ± 1.9 mmHg and no or trivial valvular regurgitation. Conclusions: The Biovalsalva prosthesis should be considered for patients requiring a biological aortic root replacement. It offers an “off‐the‐shelf” preassembled composite biological valve conduit with excellent hemostatic and hemodynamic properties. (J Card Surg 2010;25:321‐326)