Abstract 18168: Longevity After Aortic Root Replacement: Is the Mechanically Valved Conduit Really the Gold Standard for Quinquagenarians?
OBJECTIVE The impact of the conduit on longevity after root/ascending replacement, particularly in patients between the age of 50 and 60 remains controversial.
METHODS 205 patients (male=155) between 50-60 years of age (mean age:55.7±2.9 years) received a stent-less porcine root (N=78) or a mechanically-valved conduit (N=127) between 02/1998-07/2011. 166 patients underwent root replacement for aneurysm (porcine=39%[N=65];mechanical=61%[N=101],p=0.5), 25 patients for acute type-A aortic dissection (porcine:32%[N=8],mechanical:68%[N=17],p=0.51) and 14 for endocarditis/iatrogenic injury (6.4%vs.7.9%); functional aortic status was stenosis in 45% (N=92), regurgitation in 50% (N=102) and combinded in 5% (N=11).
RESULTS Overall hospital mortality was 6.8% (7.7% for porcine and 6.3% for mechanical root replacement,p=0.78). Freedom from aorta-related reoperation@12-years was equivalent (porcine:96.2% vs.mechanicals: 98.4%,p=0.37). Concomitant procedures were CABG(10%), MVR(10%), partial/complete arch(11%/3%)--with no significant differences between porcine vs. mechanical root replacement. Follow-up averaged 5.4±3.7years (1097 pt-years). Longevity was equivalent between both groups with a 5-year-survival of 86% (porcine:89%; mechanicals:85%),and a 10-year-survival of 76% (porcine:81%; mechanicals:75%;p=0.66): the linearized mortality rate (LMR) was 3.1%/pt-year (porcine:2.9%/pt-year;mechanicals:3.2%/pt-year).
CONCLUSION Longevity after biological root repair with new-generation stent-less porcine roots is equivalent to mechanical root replacement in Quinquagenerians. Biological root replacement should be strongly considered as an excellent alternative in patients with contraindications for coumadin particularly with the option of future transcatheter valve-in-valve repair.
- © 2012 by American Heart Association, Inc.