Long-term follow-up after aortic root replacement with the Shelhigh® biological valved conduit: a word of caution!

Şahin, Ayhan; Müggler, Oliver; Sromicki, Juri; Caliskan, Etem; Reser, Diana; Emmert, Maximilian Y.; Alkadhi, Hatem; Falk, Volkmar; Holubec, Tomáš

doi:10.1093/ejcts/ezw167

Cited by 16 publications

(19 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…They reported an unexpectedly high rate of death along with an elevated number of reoperations (8.6%) during the midterm follow‐up, mostly due to endocarditis and aorto‐ventricular disconnection or false aneurysm formation of the conduit 15 . Similar results were reported 1 year later by Sahin et al, 16 analyzing a cohort of 63 patients implanted with the same conduit at a median follow‐up of 9.5 years. They reported a surprisingly high rate of prosthesis‐related deaths (6.4%), endocarditis (17%) and reoperations (16%), and advised against the use of the Shelhigh conduit.…”

Section: Discussionsupporting

confidence: 64%

Long‐term follow‐up after Bentall operation using a stentless Shelhigh NR‐2000 bio‐conduit

et al. 2020

View full text Add to dashboard Cite

Background: To analyze the long-term results after Bentall operation using the stentless Shelhigh No-React (NR)-2000 bio-root prosthesis.Material: From 2004 to 2008, 26 consecutive, nonselected patients (mean age at surgery: 67 ± 9 years) underwent a Bentall operation using a stentless Shelhigh valved conduit at our institution. Mean preoperative Logistic-EuroSCORE was 17.1 ± 12.9. The mean size of the aortic root was 53.2 ± 5 mm. The mean preoperative ejection fraction was 55 ± 7.4%. Three patients had a bicuspid valve. One patient with acute endocarditis and one patient with type A aortic dissection were operated on an emergency. Three patients (11.54%) had a previous cardiac operation. The Button-Bentall technique was used in all cases. Seven patients (26.92%) received an associated procedure. The mean size of the implanted prosthesis was 26.1 ± 2.2. Follow-up ranged between 6 and 174 months (mean 93.4 ± 59.1 months).Primary endpoints consisted of early and late mortality, freedom from acute endocarditis, freedom from structural valve deterioration, and freedom from valverelated-reoperation.Results: Two patients died in hospital, while 10 patients died during follow-up time, of which three for cardiac causes (12.5%). Overall survival probability was 52.9% at 15 years. Freedom from acute endocarditis was 95.7% at 5 and 15 years. Freedom from severe aortic incompetence due to structural deterioration was 100% at 5 and 10 years, 90.9% at 15 years. The mean aortic gradient at follow-up was 11.4 ± 5 mm Hg.Freedom from valve-related reoperation was 100% at 5 and 10 years, 90.9% at 15 years. Conclusions: In our experience, Bentall's operation using the Shelhigh NR-2000 stentless bio-conduit provided satisfactory early and long-term results. However, our findings are not consistent with unfavorable long-term outcomes following the implantation of this device reported by other authors. K E Y W O R D S aortic root, aortic valve, biological graft How to cite this article: Stefanelli G, Pirro F, Macchione A, Bellisario A, Weltert L. Long-term follow-up after Bentall operation using a stentless Shelhigh NR-2000 bio-conduit. J Card Surg. 2020;35:988-995.

show abstract

Section: Discussionsupporting

confidence: 64%

Long‐term follow‐up after Bentall operation using a stentless Shelhigh NR‐2000 bio‐conduit

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Studies have reported cases of degradation or stenosis of No-React products used cardiac and thoracic surgery. [12][13][14] In contrast, other centers with even larger patient cohorts have not reported such issues. 15,16 Because of our aforementioned case and the reported data, we have implemented a more rigorous follow-up.…”

Section: Discussionmentioning

confidence: 95%

Novel prefabricated bovine pericardial grafts as alternate conduit for septic aortoiliac reconstruction

Burghuber

Konzett

Eilenberg

et al. 2021

Journal of Vascular Surgery

View full text Add to dashboard Cite

Objective: Infection of prosthetic aortic grafts represents a serious complication with high morbidity and mortality. Replacement with autologous material is recommended; however, in its absence, biological material should be favored.In the present retrospective cohort study, we evaluated the short-and midterm results with the use of commercially available prefabricated bovine pericardium grafts (BPGs) used for the management of aortic graft infection or aortic reconstructive surgery in the presence of systemic infection.Methods: We performed a retrospective analysis of patients in whom BPGs had been used for aortic reconstruction at two vascular centers. Prefabricated vascular pericardium grafts were preferred over other biological reconstruction techniques for selected cases. Comorbidities, procedure-related details, perioperative morbidity, clinical outcomes, and mortality were analyzed.Results: From 2014 to 2019, 21 patients had received BPGs at two Austrian vascular centers. Their median age was 63 years (interquartile range [IQR], 55-71 years), the patients were predominantly male (76%), and the median body mass index was 25.3 kg/m 2 (IQR, 21.7-27.3 kg/m 2 ). The major comorbidities included arterial hypertension, peripheral artery disease, smoking, and chronic pulmonary disease. The indications for surgery were vascular graft or endograft infection in 62% and aortic reconstruction in the presence of systemic infection in 38%. Three patients (14%) had aortoenteric fistulas. Surgery was technically successful in all cases. The median follow-up was 21.6 months (IQR, 6.0-34.6 months). The 30-day mortality was 9.5%. The 1-and 2-year overall survival was 84% and 75%, respectively. Of the 21 patients, 89% had remained free of recurrent infection. One of the two reinfections had resolved after treatment of the underlying focus. At 2 years, the primary and assisted primary patency rates were 86% and 94%, respectively. No limbs were lost during follow-up.Conclusions: Prefabricated BPGs represent a promising alternative for the management of aortic graft infections and aortoiliac reconstruction in the presence of systemic infection.

show abstract

“…Perhaps the sterile abscess formation was suggested to be due to an immunogenic reaction to the xenograft manifested as xenogeneic complement-mediated graft rejection. 19,20 Furthermore, early failure of the Shelhigh pulmonary valve conduit used for right-sided reconstruction in infants was reported by Pearl et al and was explained to be due to foreign body reaction leading to pseudointimal peel formation and subsequent early conduit stenosis. 21…”

Section: Commentsmentioning

confidence: 99%

Placement of Labcor Pulmonary Conduit Results in a High Incidence of Postoperative Fever

Shaker

Arabi

Khafaja

et al. 2021

World J Pediatr Congenit Heart Surg

View full text Add to dashboard Cite

Background: Fever in the postoperative period in cardiac patients is common. The purpose of this study is to recognize the risk factors for prolonged postoperative fever in cardiac patients with pulmonary conduit insertion. Methods: Patients were identified retrospectively by looking at the International Classification of Diseases, Ninth Revision, Clinical Modification procedure code for pulmonary conduit insertion between June 2009 and December 2015 at the American University of Beirut Medical Center. Data about preoperative, perioperative, and postoperative variables were collected. Data entry and analysis were performed using SPSS version 22. Results: The study identified 59 patients. The most common type of pulmonary conduit used was the Contegra type (57.6%) (n = 34), followed by the Labcor type (20.3%; n = 12). Postoperative fever occurred in 61% of patients (n = 36). Fourteen patients (38.8%) had a prolonged fever that lasted for more than seven days. Prolonged postoperative fever was significantly associated with the Labcor pulmonary conduit ( P value < .001) and a longer duration of pacing wires ( P value: .039). Significantly prolonged fever that lasted for more than 21 days occurred in five patients who all had inserted the Labcor pulmonary conduit. Conclusions: The Labcor pulmonary conduit type is a risk factor for prolonged postoperative fever. The protracted use of pacing wires could be a consequence of the prolonged fever rather than a cause. In the absence of a demonstrable infectious etiology for prolonged postoperative fever in cardiac patients with pulmonary conduit insertion, the Labcor pulmonary conduit could be the underlying cause. Alternative management of such cases may lead to decreased antibiotic use and morbidity.

show abstract

Long-term follow-up after aortic root replacement with the Shelhigh® biological valved conduit: a word of caution!

Cited by 16 publications

References 21 publications

Long‐term follow‐up after Bentall operation using a stentless Shelhigh NR‐2000 bio‐conduit

Long‐term follow‐up after Bentall operation using a stentless Shelhigh NR‐2000 bio‐conduit

Novel prefabricated bovine pericardial grafts as alternate conduit for septic aortoiliac reconstruction

Placement of Labcor Pulmonary Conduit Results in a High Incidence of Postoperative Fever

Contact Info

Product

Resources

About