Early and midterm outcomes of a bentall operation using an all-biological valved BioConduit™

Abstract

Objectives: To analyze the midterm results of aortic root replacement using the valved, all biological, No React®, BioConduit™.

Methods: From 2017 to 2020, we prospectively followed 91 consecutive patients who underwent a Bentall procedure with a BioConduit™ valved graft in our institution. The primary outcomes were aortic bioprosthetic valve dysfunction and mortality according to Valve Academic Research Consortium 3 (VARC3).

Results: Mean age was 70 ± 10 years and 67 patients (74%) were men. Ascending aortic aneurysm (72%), aortic valve regurgitation (51%) or stenosis (20%) and acute endocarditis (14%) were the main indications for surgery. Seventy-four patients (81.3%) were followed up at 1 year. The perioperative mortality was 8% (n = 8), the early, 1 year, mortality was 2% (n = 2) and the midterm mortality, at 4 years of follow up, was 4% (n = 3). Ten patients fulfilled the criteria for hemodynamic valve deterioration at 1 year (13%) and 14 for a bioprosthetic valve failure during the entire follow-up (17%).

Conclusions: We are reporting early and midterm results of Bentall procedures with the all-biological, valved, No-React® BioConduit™. To our knowledge, this is the first study reporting an early and midterm unexpectedly high rate of non-structural prosthetic hemodynamic deterioration. The rate of endocarditis and atrioventricular disconnections remain similar to previous studies.

Fig. 1

A Transesophageal echocardiography, deep transgastric view, annular hyperechogenic structure (yellow arrow); LVOT—left ventricle outflow tract; B Intraoperative view with the annular diaphragmatic structure (black arrow) visualized after complete prosthetic dissection

Fig. 2

Transthoracic echocardiography, long axis parasternal view with same patient early post-operatory (A) and (C) and 1-year follow up exam (B) and (D), showing a shrinkage of the aortic annulus at 1 year (measured at the level of the yellow arrows), from 18 to 14 mm (A) and (C) together with a transaortic mean gradient and maximal velocity by Doppler continuous wave interrogation, from 2,4 m/sec and 12 mmHg (B) to 4,6 m/sec and 59 mmHg (D)