Early Experience with a Prefabricated Bioprosthetic Aortic Valved Conduit

P0116 

Abstract Submission 

Rolando Calderon (1), Alberto Pochettino (2), Juan Crestanello (2), Arman Arghami (2), Phillip Rowse (2), Molly Klanderman (3), Gabor Bagameri (2), Nishant Saran (1), Philip Spencer (4), Richard Daly (2), Joseph Dearani (5), Malakh Shrestha (6)

(1) N/A, Rochester, MN, (2) Mayo Clinic, Rochester, MN, (3) Mayo Clinic, Phoenix, AZ, (4) Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, (5) Mayo Clinic, United States, (6) Mayo Clinic (Rochester, MN), Rochester, MN

Rolando Calderon    -  Contact Me
N/A

*Alberto Pochettino    -  Contact Me
Mayo Clinic

*Juan Crestanello    -  Contact Me
Mayo Clinic

Arman Arghami    -  Contact Me
Mayo Clinic

Phillip Rowse    -  Contact Me
Mayo Clinic

Molly Klanderman    -  Contact Me
Mayo Clinic

Gabor Bagameri    -  Contact Me
Mayo Clinic

Nishant Saran    -  Contact Me
N/A

Philip Spencer    -  Contact Me
Department of Cardiovascular Surgery, Mayo Clinic

*Richard Daly    -  Contact Me
Mayo Clinic

*Joseph Dearani    -  Contact Me
Mayo Clinic

*Malakh Shrestha    -  Contact Me
Mayo Clinic (Rochester, MN)

Rolando Calderon    -  Contact Me
N/A

Objective: Evaluate the early postoperative morbidity, mortality, and prosthetic valve function of patients who underwent aortic root replacement using a prefabricated bioprosthetic aortic valved conduit.
Methods: Single-center retrospective review of 89 consecutive adult patients who underwent aortic root replacement with a prefabricated bioprosthetic aortic valved conduit from 2021 to August of 2023, this included patients with urgent operative status (19), re-do cardiac operations (25), and endocarditis (12).
Results: Most patients were male (71), mean age was 69.1 (±7.7) years. Indications for operation were thoracic aortic aneurysms in 51 patients, endocarditis in 12, structural valve deterioration of prior prosthetics in eight, and aortic dissection in six patients. Isolated aortic root replacement was performed in 57 patients, concomitant CABG in 11, concomitant valve operations in 11, and other combinations in 10 patients.
Implanted valve sizes were 29 mm (29/89), 27 mm (26/89), 25 mm (24/89), and 23 mm (9/89). The extent of aortic repair included the aortic root and ascending aorta in 28 patients, hemi-arch in 58, and total arch with elephant trunk in three patients. Mean cardiopulmonary bypass time was 256 (±135.2) min, mean cross-clamp time was 195 (±83.2) min, circulatory arrest was used for 58 patients with a mean duration of 20 (±8.3) min. 30-day mortality occurred in four patients of whom four were re-do operations, and one was due to endocarditis, postoperative ECMO support was required in eight patients, and intra-aortic balloon pump in three patients, re-operation for bleeding was necessary in three patients, of which two were complex reoperative cases. Postoperative renal failure requiring dialysis occurred in 13 patients, no patients developed postoperative strokes.
Discharge echocardiogram was obtained in 85 patients, and follow-up assessment was available in 35 patients with a median follow-up time of 4.1 months. Prosthetic aortic valve gradient, effective orifice area, and doppler velocity index remained within normal limits (Table), importantly, no patient prosthesis mismatch was noted.
Conclusions: The prefabricated bioprosthetic aortic valved conduit was used in all patients with root repairs including complex re-operative scenarios and endocarditis with acceptable short-term morbidity and mortality. The hemodynamic performance of the valve within the studied period was normal, the long-term durability is yet to be proven.

Aortic Root