Composite stentless valve with graft extension for combined replacement ofthe aortic valve, root and ascending aorta

Objective: The composite mechanical valve conduit has been most commonly us ed for patients who require combined aortic valve, root,and ascending aorta replacement, but is limited, especially in the elderly, because of the nee d for long-term anticoagulation. We report the first consecutive series of patients in whom a composite stentless valve with graft extension, which do es not require long-term anticoagulation, was performed. Methods: Between A pril 1998 and July 2000, eight patients with severe aortic root and ascendi ng aortic pathology underwent a combined aortic valve, root, and ascending aorta replacement with a Freestyle((R)) stentless porcine valve with a Hema shield((R)) graft extension. Mean age was 74 (range 56-82), three were male s. Concomitant procedures included coronary artery bypass graft (CABG) alon e (n = 2), mitral valve replacement with atrial septal defect repair (n = 1 ) and CABG with septal myomectomy (n = 1). Results: Operative mortality was zero. Median aortic cross-clamp and cardiopulmonary bypass times were 150 and 203 min, respectively. Two patients returned to the operating room for bleeding. Median blood transfusions and hospital length of stay were 4 unit s and 11 days, respectively. Conclusions: The composite stentless valve wit h graft extension is a reasonable alternative to a mechanical valve conduit for patients who require a combined aortic valve, root, and ascending aort a replacement, in whom anticoagulation is not desirable or contra-indicated . (C) 2001 Elsevier Science B.V. All rights reserved.