Aortic Root Enlargement with Glycerol-preserved Homologous Dura Mater Patch during Aortic Valve Replacement

Abstract

Aortic root enlargement with a patch is sometimes indicated either to prevent aortic homograft valve distortion during implantation or to facilitate easy, tension-free closure of the aortotomy. Patches made of prosthetic material have been widely used for this purpose. The use of autogenous pericardium has recently been reported. Although dura mater has been shown to have great strength, low antigenicity, athrombogenicity, easy availability in large sizes and rapid bonding to most tissues, its use for patch enlargement of the aortic root has not been previously documented. From 1979 to 1983, 38 patients had dura mater aortic root gussets placed during aortic valve replacement at the Southampton General Hospital. In all cases, the patches were placed to facilitate aortic closure, or to prevent homograft valve distortion by enlarging the non-coronary sinus. Aortic homografts were implanted in 11 patients, Carpentier Edwards' Xenograft valves in 16, Björk-Shiley valves in 8 and Wessex Xenografts in 3 patients. All the patients survived and in a mean follow-up of 30 +/- 12.8 months (range 3 to 48 months) there has been no clinical evidence of patch failure due to leakage, rupture or aneurysm formation. These results suggest that glycerol-preserved dura mater is a satisfactory patch material for aortic root enlargement during aortic valve replacement.

Resultado da substituição aórtica por ampliação anelar anterior e posterior é comparável a do anel normal

“…In all of these cases, an ample graft is sutured from the inferior portion of the incision, to arrange the enlargement and to reconstruct the aorta. The published results for the posterior enlargement indicate a reduction in the hospital mortality to almost zero [12,13], although there is a possibility of complications related to the mitral valve functioning.…”

Dupla ampliação anterior e posterior do anel aórtico para substituição valvar

“…A mortalidade operatória, inicialmente de 40 % (1) ou 25 % (2) , reduziu-se a próximo de zero (18)(19)(20) . Complicações relativas à função da valva mitral foram citadas, sendo mais grave a ruptura na sutura do enxerto no local de reconstrução do folheto anterior.…”

Hemodynamic and Angiographie Late Results Following Enlargement of Narrow Aortic Root Using Autologous Pericardium in Prosthetic Aortic Valve Replacement

“…card iovasc. Surgeon 33 ( 1985)293as dura mater was only seldom empl oyed(21) . Some surgeons strengthene d autologous pericardium by syn the tic mate rial (1 8, 24) .…”