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The Journal of Cardiovascular Surgery 2019 Dec 06

DOI: 10.23736/S0021-9509.19.11098-1

Copyright © 2019 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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

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