Aortic Root Replacement with Stentless Bioprosthesis – Outcome Comparison with Bioprosthetic AVR plus Ascending Aorta Replacement

Kay-hyun Park, Hak Joo Kim, Dong Jung Kim, Jun Sung Kim, Cheong Lim

Seoul National University Bundang Hospital, Seongnam, Korea (South)

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – C

Abstract

Purpose Stentless bioprostheses (porcine root) are not being widely used because they tend to be regarded technically complex to implant. This study aimed to examine the safety of aortic root replacement with stentless bioprostheses (Stentless-ARR) by comparing the clinical outcome with aortic valve replacement using stented bioprostheses combined with supracoronary ascending aorta replacement (Asc-AVR).

Methods For 71 Stentless-ARR and 44 Asc-AVR patients who underwent surgery by a single surgeon between April 2006 and May 2017, medical records were reviewed to investigate the preoperative features, operation details, and postoperative outcome.

Results Indications for Stentless-ARR included root dilatation (60.6%), small annulus (19.7%), aortic dissection (5.6%), and infective endocarditis with periannular abscess (2.8%). The preoperative characteristics including the mean age (71.2±6.6 vs 72.5±5.5 years) and incidence of concomitant procedures were not different between the two groups except for higher prevalence of aortic valve insufficiency in Stentless-ARR group. Although Stentless-ARR group required longer operation time, the difference did not exceed 30 minutes; the median (QL-QU) CPB and aortic clamping durations were 152 (140-204) vs 132 (111-183) min and 126 (110-158) vs 104 (85-132) min (p<0.05), respectively. The early mortality rate (1.4% vs 2.3%) and incidences of bleeding (7% vs 6.8%) and other complications were not different. Postoperative ICU stay and admission duration were also not different; 26.5 (23-49) vs 26 (23.5-43.5) hours and 10 (8-17) vs 10 (7-15.5) days. 5-year valve-related survival was 96.1% in Stentless-ARR group and 90.5% in Asc-AVR group.

Conclusion Stentless-ARR is a viable option of bio-Bentall procedure safely applicable for various lesions of the aortic root and valve.