Clinical Outcomes after Aortic Root Replacement with Valved Conduits in Valve Sparing Era

Kenji Wada, Shuichiro Takanashi, Tomoya Uchimuro, Atsushi Shimizu, Kosaku Nishigawa

Sakakibara Heart Institute, Tokyo, Japan

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – C

Abstract

Objective: The stable aortic root replacement was essential in the age of trying the Valve Sparing positively. This study aimed to evaluate surgical outcomes after complete aortic root replacement using valve conduits (Bentall operations).

Methods: From 2004 to 2017, 477 patients underwent aortic root replacement using either a mechanical Bentall 312, or a biological Bentall 165 valve conduit at our hospital. Preoperative data was stratified according to the type of valve graft, and treatment bias was addressed by propensity score analysis. We obtained 2 analogous cohorts of 88 patients for mechanical Bentall (MB group) and biological Bentall procedure (BB group).

Results: After a mean follow-up time of 58± 43 months, hospital mortality between them was comparable (MB = 3.9% and BB = 7.3% , P = 0.1). Cumulative survival at 5 and 10 years was 82.9% and 75.2% for MB group, and 80.8% and 67.3% for BB group respectively (P = 0.35). Freedom from cardiac death at 5 and 10 years was 92.9% and 91.1% for MB group, and 88.8% and 76.9% for BB group respectively (P = 0.22). They also had similar results for freedom from bleeding events and re-interventions. Propensity-adjusted Cox-regression analysis showed the independent predictor of late mortality was age [hazards ratio (HR): 1.04, P < 0.001], coronary heart disease (HR: 1.86, P = 0.02), and pre-operative shock (HR: 3.612, P = 0.001). Aortic dissection, Marfan syndrome, and infective endocarditis were not independent risk predictor.

Conclusion: Aortic root replacement with valve conduits is a safe and acceptable therapeutic benefit. The choice of either a mechanical or a biological valve graft seems to have no influence on early and late adverse outcomes including hemorrhagic events and need for re-interventions.