Home > Journals > The Journal of Cardiovascular Surgery > Past Issues > Articles online first > The Journal of Cardiovascular Surgery 2019 Dec 06



To subscribe
Submit an article
Recommend to your librarian


Publication history
Cite this article as



The Journal of Cardiovascular Surgery 2019 Dec 06

DOI: 10.23736/S0021-9509.19.11098-1


language: English

Mid-term single-centre outcomes of BioIntegral compared to Freestyle aortic conduit implantation

Arash MEHDIANI 1, Vitaly A. SOROKIN 2, 3 , Jai SULE 3, Konstantinos SMIRIS 1, Dmytro STADNIK 1, Artur LICHTENBERG 1, Alexander BLEHM 1

1 Department of Cardiovascular Surgery, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany; 2 Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; 3 Department of Cardiac, Thoracic and Vascular Surgery, National University Hospital, National University Health System, Singapore


BACKGROUND: Full aortic root replacement with biological conduit has limited options. This non-randomized cohort study aims to compare mid-term clinical and hemodynamic results of the BioIntegral (BI) composite biological versus the stentless Freestyle (FS) conduits in patients undergoing full aortic root replacement.
METHODS: From February 2013 to July 2017, 265 patients underwent aortic root replacement at a single institution (BI n=202, FS n=65). Preoperative, intraoperative and postoperative parameters, complications including stroke, myocardial infarction (MI), endocarditis and reoperation were studied. Hemodynamic performance of both conduits was analysed by echocardiography. Target endpoints were 30-day mortality, 2-year survival, 2-year freedom from major adverse valve-related and cardiovascular events.
RESULTS: Wider BI conduits were used (BI 27±2mm vs FS 25±2mm, p<0.0001). The BI group had shorter cardiopulmonary bypass (BI 165±67min vs FS 200±78min, p<0.0001) and cross-clamp (BI 102±36min vs FS 122±40min, p=0.001) times. Thirty-day mortality was similar in both groups. There were fewer conduit-related reoperations in the BI group (BI 0% vs FS 3%, p=0.012) but higher postoperative atrial fibrillation (BI 31% vs FS 17%, p=0.025). No significant differences were observed for stroke (BI 5% vs FS 10%, p=0.947), MI (BI 3% vs FS 4%, p=0.583), or infective endocarditis (BI 0% vs FS 2%, p=0.077). No significant hemodynamic differences were evident on follow-up echocardiography while an improved overall survival trend was seen in the BI group (p=0.062).
CONCLUSIONS: FS and BI provide comparable clinical midterm results and hemodynamic parameters. Simplified implantation technique providing shorter cardiopulmonary bypass and operation times are advantageous for BI.

KEY WORDS: Root replacement; BioIntegral conduit; Biological full root conduit

top of page