Composite freestyle stentless xenograft with Dacron graft extension for ascending aortic replacement.

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.

Paraplegia as a symptom of failure after endovascular therapy of type B aortic dissection in Marfan syndrome.

This report describes successful treatment of an unusual case of concomitant paraplegia and type 1 endoleak during the early postoperative course of endovascular therapy of type B dissection in a patient with Marfan syndrome.

Clinical and hemodynamic performance of the 19-mm medtronic mosaic bioprosthesis.

BACKGROUND AND AIM OF THE STUDY: The Medtronic Mosaic valve (MMV) is a latest generation supra-annular stented porcine valve, which combines a low-profile stent, leaflet fixation at zero pressure in a predilated aortic root, and amino-oleic acid anti-mineralization treatment for improved hemodynamics and durability. A study was conducted to evaluate the clinical and hemodynamic performances of the MMV in patients with a small aortic root (19 mm aortic annulus). METHODS: Between 1998 and 2004, 81 consecutive patients (69 females, 12 males; mean age 78.0 +/- 5.5 years) underwent aortic valve replacement using the 19-mm MMV. Concomitant coronary artery bypass grafting was performed in 28 patients (29.2%), and mitral valve surgery in one patient (1.2%). RESULTS: The 30-day mortality rate was 9.9% (eight deaths). Postoperative actuarial survival estimates were 90.1 +/- 3.3%, 78.5 +/- 4.6% and 69.1 +/- 5.5% at one month, one year and two years, respectively. After a mean follow up of 2.7 +/- 1.9 years, no cases of structural dysfunction, non-structural dysfunction or valve thrombosis were noted. Four ischemic cerebral complications (2.0% per patient-year (pt-yr)), five bleeding complications (2.0%/pt-yr) and two prosthetic valve infections (1.0%/pt-yr) were observed. No reoperation on a MMV was performed. Postoperatively, the mean systolic gradient was 23.4 +/- 7.0 mmHg, and the effective orifice area (EOA) 1.06 +/- 0.33 cm2. Valve prosthesis-patient mismatch (VP-PM) was moderate (indexed EOA > 0.65 cm2/m2 and < or = 0.85 cm2/m2) in 40 patients (49.4%), and severe (indexed EOA < or = 0.65 cm2/m2) in 41 (50.6%). CONCLUSION: Although providing acceptable clinical results, implantation of the 19-mm MMV resulted in a high incidence of postoperative VP-PM. Hence, this valve should be reserved for patients in whom the projected indexed EOA calculated preoperatively is deemed acceptable, given the patient's clinical condition.