Aortic root replacement with the carboseal composite graft: 7-year experience with the first 100 implants

Background. Aortic root replacement remains a challenging surgical procedur e. A variety of techniques and prosthetic devices have thus far been used. In order to assess the performance of the Carboseal (Sultzer Carbomedics, I nc, Austin TX) composite graft, review of the experience with composite roo t replacement was undertaken. Methods. Between January 1979 and December 1998, 273 patients underwent com posite aortic root replacement. One-hundred-six received the Carboseal comp osite prosthesis (group 1) and 84 other types of composite grafts (group 2) . Demographic and operative variables were similar in the 2 patient groups, except for an older mean age in group 1 (58 +/- 12 versus 50 +/- 12 years, p 0.001). Results. Operative mortality was lower in group 1 patients (3 of 106, 3% ve rsus 10 of 84, 12%, p = 0.04). Follow-up of survivors was longer in group 2 due to more recent adoption of the Carboseal grafts (93 +/- 57 versus 36 /- 23 months, p = 0.01). Late mortality was higher in group 2 (3 of 103, 3% versus 13 of 74, 18%, p = 0.01), with higher prevalence of prosthetic-rela ted complications (2 of 103, 2% versus 12 of 74, 15%, p = 0.002). Reoperati on was more prevalent in group 2 (1 of 103, 1% versus 5 of 74, 8%, p = 0.04 ), and limited to patients having root replacement using the inclusion tech nique. Functional status of survivors was comparable in the 2 groups (83 of 103, 80% versus 45 of 74, 61% of patients in New York Heart Association cl ass I, p = 0.1). Conclusions. Aortic root replacement using the Carboseal composite graft of fers excellent long-term results, with negligible prevalence of prosthetic- related complications. Superior performance compared to other available com posite grafts in the present series may be influenced by more recent adopti on of the Carboseal conduit and concomitant uniform adoption of coronary bu tton technique. (C) 1999 by The Society of Thoracic Surgeons.