STENTLESS PORCINE BIOPROSTHESES FOR ALL TYPES OF AORTIC ROOT PATHOLOGY

Objective: Conventional biological and mechanical prostheses have impo rtant limitations with regard to their results concerning thrombosis, hemorrhage and long-term durability. Aortic valve replacement with ste ntless devices results in superior hemodynamic function because obstru cting stents and sewing rims are avoided. In addition, no anticoagulat ion therapy is needed. Methods: From 1 June 1991 until 31 May 1996, 23 5 patients received aortic valve replacement with stentless aortic por cine bioprostheses. Patients' ages ranged from 24 to 88 years (mean 64 years). In 21.3% of all patients, concomitant procedures were perform ed. Coronary artery bypass graft (CABG) and mitral valve surgical ther apy were the most frequent ones (31 and 12 cases, respectively). Impla nted valve sizes ranged from 21 to 29 mm in diameter. Results: A total of 122 patients received a subcoronary implantation with the lower ro w performed with interrupted stitches and the upper row with a continu ous suture. In 99 cases we performed the inclusion cylinder technique, also with lower interrupted sutures and running upper sutures after a daptation of the coronary ostia into the graft. In the group with smal l aortic roots, the total root replacement technique (n = 14) was used . Mortality at 30 days was 4.7% (11/235). Echocardiography at discharg e postoperatively revealed a mean gradient across the prosthesis of 6 mm Hg. Color Doppler suggested no or trivial regurgitation in 93% of a ll examined patients and mild regurgitation without clinical symptoms in 7%. Up to now, 98.2% of all discharged patients have been free of v alve-related reoperation. Conclusions: With implantation of stentless bioprostheses, an improved hemodynamic function will be obtained. Almo st every aortic root pathology can be safely treated with any of the t echniques described. The short and intermediate results seem to be at least equal to any other prostheses or treatment methods. The long-ter m performance of these devices is still under investigation. (C) 1997 Elsevier Science B.V.