Comparison of MID-term hemodynamic performance between the biovasalva and the biointegral valved conduits after aortic root replaycement

OBJECTIVES: The study compares the hemodynamic performance of the BioValsalva and BioIntegral biological aortic valved conduits in the aortic root position.

METHODS: Between July 2008 and May 2014, a total of 55 patients underwent aortic root replacement using BioValsalva (BV) conduit (n = 27) or BioIntegral (BI) conduit (n = 28) in the University Hospital of Essen. The indication for surgery was aneurysm of the aortic root in 42 patients (76.3%), acute type A aortic dissection in 11 patients (20%) and aortic valve endocarditis with abscess in 2 patients (3.6%). There were no patients with Marfan syndrome. To evaluate the hemodynamic performance of the prosthetic valve, the mean pressure gradient (MPG) and the effective orifice area (EOA) were measured. Mid-term echocardiography and follow up was performed.

RESULTS: There was no significant difference in the demographic variables between patients in BV and BI groups. The median aortic cross-clamp time was not significantly different 105.0 min [(25th to 75th percentiles): 74.0 – 140.5] for BV vs. 102.5 min (80.0 – 135.0) for BI (P 0.824). Concomitant procedures were performed in 16 (59.3%) vs. 20 (71.4%) patients (P 0.344). Thirty-day mortality was not significantly different, 3 (11.1 %) vs. 1 (3.6 %) (P 0.474). Mid-term follow up was longer for BV 106.0 months (67.4 – 123.9) vs. 85.0 months (72.0 – 87.9) for BI due to the novelty of BI conduit in our center (P 0.012). In follow up, 8 (33.3%) patients in the BV group died compared to 5 (18.5%) in BI group (P 0.336). Echocardiography was done in mid-term follow-up. The MPG across all valve sizes was as follow: 11.9 ± 3.7 mmHg for BV and 9.5 ± 3.6 mmHg for BI (P 0.066). The EOA across all valve sizes was as follow: 1.85 ± 0.4 cm² for BV and 1.81 ± 0.3 cm² for BI (P 0.723).

CONCLUSION: The use of biological valved conduits is increasing due to the aging of the population and the durability of the new biological valved conduits. We compared the mid-term hemodynamic performance of two commonly used biological aortic valved conduits. We report the outstanding mean pressure gradients, effective orifice areas and low rates of aortic regurgitation for all implanted conduits during the follow-up with no significant difference between both groups. Before suggesting a specific aortic-valved biological conduit, more randomized studies with detailed echocardiographic data are needed to evaluate the long-term durability, performance and valve-related morbidity of these innovative aortic-valved biological conduits.



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