Aortic root replacement with stentless porcine xenografts: early and late outcomes in 132 patients

Abstract

Background: Traditionally, aortic root replacement has most commonly involved mechanical composite valve grafts, which have excellent durability but necessitate lifelong anticoagulation. Stentless porcine xenografts (bioroots) are a recently developed alternative that enable root replacement without the necessity of long-term anticoagulation. This study examined the early and late outcomes of aortic root replacement with porcine bioroots.

Methods: Porcine bioroots were used for root replacement in 132 patients. Of these, 129 (97.7%) required graft extensions for ascending aortic replacement, and 55 (41.7%) underwent aortic arch replacement. Twenty-three operations (17.4%) were reoperations. Twenty-four patients (18.2%) had aortic dissection. Early and late outcomes were ascertained by reviewing medical records. Changes in New York Heart Association (NYHA) class were used to assess improvements in functional status. Follow-up echocardiography results were reviewed to assess bioprosthetic valve function and changes in left ventricular ejection fraction.

Results: There were 10 operative deaths (7.6%), 9 of which were directly related to intraoperative ventricular failure. Nine patients (6.8%) had late valve-related complications, including 5 patients with prosthetic endocarditis (3 died), 1 annular pseudoaneurysm, and 3 sudden, unexplained deaths. Survivors' NYHA status and left ventricular ejection fraction improved significantly. No structural valve dysfunction was evident during follow-up. Actuarial survival was 85.6% +/- 3.1% at 1 year and 77.8% +/- 4.8% at 5 years.

Conclusions: Aortic root replacement with porcine xenografts can be performed with respectable early and late outcomes, even when combined with aortic arch replacement. Further follow-up is necessary to evaluate long-term bioroot durability.