Durability of Porcine Bioroots in Younger Patients With Aortic Root Pathology: A Propensity-Matched Comparison With Composite Mechanical Roots

Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
The Annals of thoracic surgery (Impact Factor: 3.85). 08/2011; 92(6):2054-60; discussion 2060-1. DOI: 10.1016/j.athoracsur.2011.02.020
Source: PubMed


We present a comparison of porcine bioroot and composite mechanical root replacement in a large series of patients younger than 60 years who required full root replacement for true root pathology.
Between 1997 and 2007, we performed 986 aortic root replacement procedures, including 391 porcine bioroots and 515 composite mechanical roots for true root indications. Of these, 504 patients were younger than 60 years old at time of the operation. Porcine bioroots were placed in 138 patients, including 38 St. Jude Toronto Root (St. Jude Inc, St. Paul, MN), 98 Medtronic Freestyle (Medtronic Inc, Minneapolis, MN), and 2 Edwards Prima (Edwards Lifesciences Inc, Irvine, CA). Standard univariate, logistic regression, Cox regression, and propensity matching techniques were used.
To adjust for baseline differences in risk factor profiles, propensity matching yielded a final matched data set of 128 matched pairs, with no differences in preoperative risk factor profile or indication for operation. Overall 30-day operative mortality was 2.3% for porcine bioroot patients vs 1.6% for mechanical root patients (p = 0.6). Root type did not influence early (odds ratio, 0.8; 96% confidence interval, 0.2 to 3.2) or late mortality (hazard risk, 1.4; 95% confidence interval, 0 0.5 to 3.8). Multivariate predictors of late mortality included (hazard ratio, 95% confidence interval) age in years (1.01; 1.01 to 1.03), chronic renal failure (3.6; 1.1 to 12.6), and preoperative bacterial endocarditis (3.6; 1.1 to 11.8). Freedom from reoperation was similar between groups; however, bleeding events were more common among mechanical root patients.
Porcine bioroots provide durable midterm to late-term outcomes after aortic root replacement for true root indications and are an appealing alternative in younger patients because they limit morbidity associated with anticoagulant-related bleeding.

8 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: The superior hemodynamics and excellent long-term clinical performance of stentless xenografts are well described. However, the early and midterm clinical outcomes of stentless valves in patients with acute type A dissection are widely unknown. The current study evaluated the early and midterm clinical outcomes of stentless bioprosthesis for repair of acute type A aortic dissection. Methods: Between May 2005 and December 2009, 24 of 80 patients underwent root replacement using the Medtronic Freestyle xenograft (Medtronic Inc, Minneapolis, Minn) at the Meijer Heart Center. Prospective data collection was used for retrospective review. Univariate comparisons of preoperative, intraoperative, and postoperative variables were performed between patients who underwent stentless root bioprosthesis for the correction of acute type A aortic dissection (n = 24). Results: The mean age of patients was 57 years, with 15 patients aged less than 65 years. Axillary and femoral artery cannulation were used in 16 patients (67%) and 7 patients (29%), respectively. Median crossclamp and cardiopulmonary bypass times were 198 minutes (92-480 minutes) and 288 minutes (109-588 minutes), respectively. Median circulatory arrest time was 28 minutes (24-50 minutes). Operative mortality rate was 25%. Actuarial 5-year survival was 62.5%. No patients required redo aortic root replacement. Conclusions: Stentless valve implantation can be accomplished with satisfactory early and midterm clinical outcomes and is a valuable option in patients with acute aortic dissection who require root replacement.
    The Journal of thoracic and cardiovascular surgery 06/2012; 145(6). DOI:10.1016/j.jtcvs.2012.05.029 · 4.17 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Stentless porcine bioroots and pericardial composite roots were developed as prostheses that avoid the anticoagulation necessary for mechanical composite roots. Data on the hemodynamics of all root replacements are lacking and questions remain regarding comparative performance. Methods: This study evaluated patients receiving a stentless porcine bioroot, a pericardial, or a mechanical composite root at a single institution from January 2000 to December 2008. All patients underwent preoperative, postoperative and greater than 1-year echocardiograms. All root replacements were performed for aortic insufficiency or aneurysm. Median follow-up was 3.3 years (1 to 8 years). Results: There were no significant differences in preoperative left ventricular ejection fraction, aortic valve peak gradient, mean gradient, left ventricular end diastolic diameter, and left ventricular end systolic diameter. Postoperative peak and mean gradients in mechanical composite roots were significantly higher than stentless porcine bioroots. At greater than 1 year, stentless porcine bioroots had significantly lower peak and mean gradients than both mechanical composite roots and pericardial composite roots. The end diastolic diameter was also significantly smaller in stentless porcine bioroots at greater than 1 year than mechanical composite roots. Conclusions: All prostheses resulted in favorable hemodynamic and ventricular remodeling. Stentless porcine bioroots had the lowest gradients at greater than 1 year of all root replacements, with significantly better ventricular remodeling when compared with mechanical composite roots. Pericardial roots also had favorable hemodynamics and ventricular remodeling, suggesting that they are a viable alternative.
    The Annals of thoracic surgery 08/2012; 94(6). DOI:10.1016/j.athoracsur.2012.06.012 · 3.85 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: The various uses of biological valves for either aortic or mitral valve replacement have recently increased because of the growing proportion of elderly patients requiring surgery. Results: The durability of recent xenografts has been reported to be over 90 % at 10 years after aortic or mitral valve replacement for elderly patients more than 65 years of age, and therefore the guidelines now recommend the use of bioprostheses for patients over 65 years of age. Bioprostheses are also recommended for valve replacement of the right side of the heart by several authors; however, no clear guidelines are available. Trans-catheter aortic valve replacement and percutaneous pulmonary valve implantation are promising procedures for high-risk patients, although evaluation of the long-term durability of these valves is mandatory. Conclusions: This article will review the development of the tissue valve for valve surgery.
    General Thoracic and Cardiovascular Surgery 01/2013; 61(4). DOI:10.1007/s11748-013-0202-z
Show more

Similar Publications