Contemporary results of aortic root replacement with a novel prosthesis in 143 patients

Replacement of the aortic root is undertaken for a variety of different pathological conditions. We report the combined early results from two centres in the United Kingdom using a composite valve graft conduit consisting of a bileaflet mechanical valve incorporated into a gelatin impregnated, ultra-low porosity woven polyester graft (Carbo-Seal®). Between August 1992 and March 1997, 143 patients underwent aortic root replacement with the Carbo-Seal® composite prosthesis. There were 112 males (78%) and 31 females (22%) with a mean age of 56.4 years (range 15-80). The indication for surgery was acute type A dissection in 31 (22%), chronic type A dissection in 9 (6%), ascending aortic aneurysm without dissection in 100 (70%) and false aneurysm of the ascending aorta in 3 (2%). Twenty seven patients (19%) had undergone previous sternotomy and 40 (28%) were emergencies. Concomitant procedures were performed in 38 (27%), including 18 aortic arch or hemi-arch replacements. Marfan's syndrome was present in 27 (19%). Total follow up is 270 patient years. Follow up is 100% complete. The early (30 day) mortality was 7% (10 patients). Fourteen patients (10%) were re-explored for bleeding, however in no case was this related to the prosthesis. Permanent neurological events occurred in 2%. At a mean follow up of 23 months 94% of survivors were in NYHA class I. Freedom from reoperation was 97.2%±1.6 (1SE) at 12 months and 95.7%±2.1 at 48 months. Including early mortality, survival was 90.1%±2.6 at 12 months and 86.0%±3.5 at 48 months. These early and mid-term results suggest that this composite is an appropriate prosthesis to select for aortic root replacement.