USE OF BOVINE PERICARDIAL TISSUE FOR AORTIC-VALVE AND AORTIC ROOT REPLACEMENT - LONG-TERM RESULTS

Background and aims of the study: The study aimed to determine the cli nical performance of bovine pericardial aldehyde-treated products alon e or in combination with aortic leaflets of porcine origin. These incl uded a composite porcine stentless aortic valve attached to a scallope d pericardial tube (BSAV), and valved and non-valved bovine pericardia l conduits for use in left-sided heart lesions (BPG). Methods: For BSA V grafts, between January 1990 and August 1996, 163 patients (119 male s) had their aortic valves replaced by SJM Biocor(TM) BASV. Mean age w as 37.9 +/- 17.6 years (range: 1 to 76 years). Rheumatic heart disease sequelae (n = 72) and replacement of a prosthetic heart valve (n = 46 ) were predominant. Pre-operative NYHA functional class showed 90 pati ents (55.2%) in class III and 50 (30.7%) in class IV. BPVC and NVPC gr afts were used in 166 patients: acute aortic dissection was the main i ndication in 52 (31.3%) and chronic in 36 (21/7%). The ascending aorta was involved in 141 patients (84.9%); grafts were seldom used at othe r sites. In most patients the graft implanted was either a non-valved (n = 79) or a valved (n = 75) pericardial conduit. Twelve patients had a localized lesion and required a patch repair. Results: For BASV gra fts, the non-valve-related hospital mortality rate was 4.9%. There wer e 14.7% non-fatal complications with full recovery of all patients. Me an follow up in 141 patients was 3.0 +/- 1.4 years (range: 1 month to 7.2 years); 14 patients were lost to follow up. Late, non-conduit-rela ted, mortality occurred in seven patients (4.9%). Eight patients under went reoperation. The current clinical follow up of 127 patients has s hown 118 (92.9%) with competent valves and nine (7.0%) with mild stabl e aortic insufficiency. For BPVC and NVPC grafts, hospital mortality r ate was 16.9%, death being related to poor preoperative clinical condi tion. Postoperative follow up was accomplished in 125 patients; reoper ation was necessary in seven patients. Histology showed good tissue pr eservation up to five years; echocardiography revealed satisfactory fi ndings. No valved conduit had to be reoperated for valve or pericardia l tissue wear. Conclusions: Clinical results of left-sided heterologou s pericardial grafts have shown excellent performance over time. The B ASV (over seven years) and BPVC and NVPC (eight years) have demonstrat ed superior results as aortic valves alone or in combination with a pe ricardial conduit.