Thorac Cardiovasc Surg 2015; 63 - V0004
DOI: 10.1055/s-0035-1555961

Extended Aortic Root Replacement with Fresh Decellularized Homografts in Dilated Ascending Aorta Associated with Aortic Valve Disease

A. Horke 1, I. Tudorache 1, S. Sarikouch 1, Ph. Beerbaum 2, H. Bertram 1, M. Westhoff-Bleck 1, D. Bobylev 1, D. Boethig 1, 2, A. Haverich 1, S. Cebotari 1
  • 1Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
  • 2Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
  • 3Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany

Background: There is no golden surgical standard for dilated ascending aorta (AAO) with aortic valve disease. The use of decellularized homografts (DH) became clinical practice for pulmonary valve replacement. We examined extended aortic root replacement (EARR) with fresh long DH for simultaneous AVR and AAO replacement. Methods: Prospective clinical follow-up of all patients who received EARR using one single fresh, unseeded aortic DH. Serial echocardiography and CMR were used to assess left ventricular parameters, aortic valve function and AAO dimensions.

Results: 13 patients (11 male) underwent EARR with coronary re-implantation since 5/2011. 6 patients had 7 previous operations in total. No early or late postoperative mortality, aortic cross-clamp time (isolated cases) was 114 ± 35 minute, aortic valve diameter at implantation 25.7 ± 1.8 mm, no endocarditis occurred during the mean follow-up period of 1.2 ± 0.8 years. Average peak gradient at latest follow-up was 9 ± 4.3 mm Hg. Mean aortic regurgitation grade (0.5= trace,1=mild) was 0.6 ± 0.5, the last LV EF was 62 ± 8%, LV EDVi 76 ± 17 ml/m2 BSA. Mean effective valve orifice area was 2.8 ± 0.3 cm2. Aortic valve z values were 0.8 ± 1.5 at the last follow-up. No dilatation was observed at any level of the graft during follow-up so far.

Conclusion: EARR represents a new approach to dilated AAO associated with AVD. We saw unique hemodynamic performance and no dilatation at any level of the implanted homograft during the early postoperative course. Repopulated aortic homografts might to establish close to normal flow patterns within the graft.