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Feasibility of a Biological Stentless-Valved Conduit for Aortic Root Replacement
Scott C. DeRoo1, Alan Stewart2, Jonathan Yang1, Elissa Landes1, Kevin Fujita1, Julie Van Hassel1, Craig Smith1, Isaac George1, Hiroo Takayama1.
1Columbia University, New York, NY, USA, 2Mount Sinai, New York, NY, USA.

BACKGROUND Aortic root replacement is increasingly relying on biologic valves. We have developed a valved-conduit constructed with a 3f aortic biological prosthesis (Medtronic Inc.) and a Valsalva graft (3f conduit) for root replacement. Implementation of the 3f conduit is made technically easier secondary to conduit flexibility and ease of manipulation, therefore permitting a running suture for annular anastomosis. Coronary reimplantation is also significantly less challenging as is evaluating for hemostasis given the nature of the graft. This study compared in-hospital outcomes with a conventional biological stented-valved conduit (stented conduit) in order to address the feasibility of aortic root replacement with the 3f conduit.
METHODS: All patients undergoing aortic root replacement with a bioprosthetic valved conduit from August 2005 to May 2013 at a single institution were reviewed.
RESULTS: A total of 356 patients were included in our analysis (133 stented conduit, 223 3f conduit). Patient demographics were not significantly different between the stented and 3f group (age: 62.2 ± 14 vs. 61.7 ± 13.6 years; male gender: 77.4% vs. 81.6 %; previous heart surgery 22% vs. 19.6 %). Rates of concomitant procedure at time of root replacement were comparable between the stented and 3f groups (35.3% vs 37.2%), with the most common concomitant procedures including CABG (19.5% stented vs. 16.6% in 3f), mitral procedure (8.3% stented vs. 5.9% 3f). Average bypass and cross clamp times were significantly shorter in the 3f vs stented conduit groups (128.0 ± 53.7 min vs 153 ± 52.7 min p<0.0001, 108.9 ±36.8 min vs 92.2± 34.2 min p<0.0001, respectively). Median ICU stay, in-hospital mortality and postop stroke were similar between groups (2 vs 2 days, 4.5% vs 2.7%, p=0.376, 3% vs 1.4% p=0.432, respectively). Reexploration for bleeding was more common in the stented group (11.3% vs 2.7%, p<0.001).
CONCLUSIONS: Short-term outcomes of aortic root replacement with the 3f conduit appear comparable with the stented conduit. The flexible nature of the 3f conduit may confer a technical advantage over the stented conduit. Additional follow-up studies are underway to evaluate long-term outcomes.

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