Modified versus Standard Mechanical Valved Aortic Conduit

Abstract

The aim of this study was to compare the hemodynamic characteristics and early clinical results of a commercially available standard aortic conduit with those of a modified valved composite graft, which consists of a mechanical valve prosthesis sewn into a vascular tube and placed in a supraannular position. The modified conduit was placed in 40 patients (group 1) and the standard conduit in another 40 patients (group 2). The early postoperative mortality rates (within 30 days after surgery) were 0% in group 1 and 5% (2 patients) in group 2; the difference was not statistically significant. The mean geometric orifice area of the valve prosthesis was significantly larger in group 1 than in group 2 (3.7 +/- 0.7 cm(2) versus 2.9 +/- 0.5 cm(2)). Early results showed a hemodynamic advantage of the modified conduit, with significantly lower transvalvular gradients.

Bentall procedure after previous aortic valve or complete root replacement: Usefulness of self-assembled aortic valve conduit

“…Use of self-assembled mechanical or biological composite grafts has been established as the routine in our center for biological valves since 1998 and for mechanical valves since 2000. 7,8 All patients underwent the operation via sternotomy. Arterial cannulation was performed through the ascending aorta whenever possible (35.7%).…”

“…Assembly of the composite grafts using mechanical and biological prostheses has been described previously. [7][8][9] In brief, a conduit was assembled during surgery using a collagen-coated woven polyester vascular graft (InterGard; Maquet Cardiovascular, La Ciotat, France). Abbreviations and Acronyms BVC ¼ biological valve conduit MVC ¼ mechanical valve conduit the valve is determined according to surgical need; for example, the skirt can be completely or partially longer if more material is necessary for anastomosing with the left ventricular outflow tract (mostly at its mitral part).…”

Long-term results after aortic root replacement using self-assembled valve composite grafts in patients with small aortic annulus

“…This technique not only offers the possibility to use a larger valve and improve the haemodynamics, but also provides excellent haemostatic features by anastomosing the fragile remnants of the aortic annulus (e.g. in re-operations or after extensive decalcification) with the flexible rim of a sealed vascular tube rather than with the rigid and uncoated sewing ring of the valve prosthesis [13]. This suture line can even be additionally secured by sewing the tube rim with the remnants of the aortic base; however, we have exercised such an option only exceptionally.…”

“…Complete aortic root replacement was carried out using selfmade mechanical or biological composite grafts, which have been established as the routine in our centre for biological valves in 1998 and for mechanical valves in 2000 [12,13]. In this technique, a mechanical valve (26) or a xenograft (3) was placed into the collagen-coated woven polyester vascular graft (InterGard; InterVascular, MAQUET Cardiovascular, La Ciotat, France), leaving a free tube margin of 5 mm, and fixed to the tube with a running mattress polypropylene suture.…”

“…In this technique, a mechanical valve (26) or a xenograft (3) was placed into the collagen-coated woven polyester vascular graft (InterGard; InterVascular, MAQUET Cardiovascular, La Ciotat, France), leaving a free tube margin of 5 mm, and fixed to the tube with a running mattress polypropylene suture. The composite graft was anastomosed to the aortic annulus with pledgeted interrupted mattress sutures passing the sutures through the aortic annulus from the ventricle to the aortic side and the free margin of the composite graft beneath the valve prosthesis from inside to outside to allow a considerable oversizing of the aortic valve, as described and illustrated in detail previously [10][11][12][13]. Coronary ostia were implanted using the Kouchoukos button technique [14] in all but 1 patient, in whom coronary revascularizations were performed due to ostial calcifications making direct implantation impossible.…”