Stentless valved composite graft for replacement of the aortic valve and ascending aorta.

BACKGROUND

Conduits with biological valves are rarely used for aortic root replacement because of technical problems when degeneration of the valve prosthesis requires reoperation. A composite graft as described could likely avoid this problem.

MATERIAL AND METHODS

Between November 1998 and November 1999, 28 consecutive patients underwent replacement of the ascending aorta and aortic valve with a stentless valved composite graft. The indication for surgery was aneurysm of the ascending aorta (26 patients) and aortic dissection (2 patients). The composite graft was assembled during surgery using a stentless porcine aortic bioprosthesis (Toronto SPV) and a woven polyester collagen-coated vascular prosthesis (InterGard).

RESULTS

There was no hospital mortality. Echocardiographic evaluation before discharge showed excellent hemodynamics with a mean transvalvular gradient of 8.5 mmHg (standard deviation I3.0 mmHg) and no regurgitation across the valve. Within a follow-up period of up to one year there was one late death because of a cerebral hemorrhage under anticoagulation.

CONCLUSIONS

The valved composite graft described offers the excellent hemodynamic performance of a stentless biological valve and is expected to avoid major technical difficulties should later replacement of the biological prosthesis due to structural failure become necessary, because only the valve cusps need to be resected, leaving the tube graft untouched.