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Aortic root replacement with the BioValsalva prosthesis

  • Davide Pacini
  • R. Di Bartolomeo

Abstract

Aortic root replacement with a composite valve graft, according to the Bentall technique and its following modifications [1, 3, 13], represents the treatment of choice for pathologies affecting the aortic root and the aortic valve. The increasing number of elderly patients with complex diseases of the aortic valve and ascending aorta, and the disadvantages of anticoagulation and thromboembolism associated with mechanical valves are stimulating the search for an ideal substitute [9, 16, 17]. Homografts, composite conduits with a biological stented or stentless valve prosthesis intraoperatively assembled and stentless xenografts are currently available, each with its advantages and disadvantages [9, 11, 12, 15, 18]. A new prepacked biological conduit, the BioValsalva porcine aortic valved conduit, has been developed offering the surgeon a new treatment option for elderly patients with combined disease of the aortic valve and root or for patients in whom anticoagulation should be avoided or is contraindicated.

Keywords

Aortic Valve Infective Endocarditis Aortic Root Aortic Valve Disease Dacron Graft 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Bentall H, De Bono A (1968) A technique for complete replacement of the ascending aorta. Thorax 23:338–339CrossRefPubMedGoogle Scholar
  2. 2.
    Byrne JG, Mihaljevic T, Lipson WE, Smith B, Fox JA, Aranki SF (2001) Composite stentless valve with graft extension for combined replacement of the aortic valve, root and ascending aorta. Eur J Cardiothorac Surg 20:252–256CrossRefPubMedGoogle Scholar
  3. 3.
    Cabrol C, Pavie A, Mesnildrey P, et al (1986) Long-term results with total replacement of the ascending aorta and reimplantation of the coronary arteries. J Thorac Cardiovasc Surg 91:17–25PubMedGoogle Scholar
  4. 4.
    De Paulis R, Nardi P, De Matteis GM, Polisca P, Chiariello L (2001) Bentall procedure with a stentless valve and a new aortic root prosthesis. Ann Thorac Surg 71:1375–1376CrossRefPubMedGoogle Scholar
  5. 5.
    De Paulis R, De Matteis GM, Nardi P et al (2002) Analysis of valve motion after the reimplantation type of valve-sparing procedure (David I) with a new aortic root conduit. Ann Thorac Surg 74:53–57CrossRefPubMedGoogle Scholar
  6. 6.
    De Paulis R, Tomai F, Bertoldo F et al (2004) Coronary flow characteristics after a Bentall procedure with or without sinuses of Valsalva. Eur J Cardiothorac Surg 26:66–72CrossRefPubMedGoogle Scholar
  7. 7.
    De Paulis R, Scaffa R, Maselli D et al (2008) A third generation of Dacron vascular grafts for the ascending aorta. Preliminary experience. Ann Thorac Surg 85:305–309CrossRefPubMedGoogle Scholar
  8. 8.
    Dossche KM, Schepens MA, Morshuis WJ, de la Riviere AB, Knaepen PJ, Vermeulen FE (1999) A 23-year experience with composite valve graft replacement of the aortic root. Ann Thorac Surg 67:1070–1077CrossRefPubMedGoogle Scholar
  9. 9.
    Etz CD, Homann TM, Rane N, Bodian CA, Di Luozzo G, Plestis KA, Spielvogel D, Griepp RB (2007) Aortic root reconstruction with a bioprosthetic valved conduit: A consecutive series of 275 procedures. J Thorac Cardiovasc Surg 133:1455–1463CrossRefPubMedGoogle Scholar
  10. 10.
    Flynn M, Iaccovoni A, Pathi V, Butler J, Macarthur KJ, Berg GA (2001) The aortic Elan stentless aortic valve: excellent hemodynamics and ease of implantation. Semin Thorac Cardiovasc Surg. 13:48–54PubMedGoogle Scholar
  11. 11.
    Gulbins H, Kreuzer E, Reichart B (2003) Homografts: a review Expert Rev Cardiovasc Ther 1(4):533–539CrossRefPubMedGoogle Scholar
  12. 12.
    Hemmer WB, Botha CA, Bohm JO, Herrmann T, Starck C, Rein JG (2004) Replacement of the aortic valve and ascending aorta with an extended root stentless xenograft. Ann Thorac Surg 78:2150–2153CrossRefPubMedGoogle Scholar
  13. 13.
    Kouchoukos NT, Karp RB (1981) Resection of ascending aortic aneurysm and replacement of aortic valve. J Thorac Cardiovasc Surg 81:142–143PubMedGoogle Scholar
  14. 14.
    Lehmann S, Walther T, Kempfert J, Leontjev S, Rastan A, Falk V, Mohr FW (2007) Stentless versus conventional xenograft aortic valve replacement: midterm results of a prospectively randomized trial. Ann Thorac Surg 84:467–472CrossRefPubMedGoogle Scholar
  15. 15.
    Musci M, Siniawski H, Knosalla C, Grauhan O, Weng Y, Pasic M, Meyer R, Hetzer R (2006) Early and mid-term results of the Shelhigh stentless bioprosthesis in patients with active infective endocarditis. Clin Res Cardiol 95:247–253CrossRefPubMedGoogle Scholar
  16. 16.
    Pacini D, Ranocchi F, Angeli E, et al (2003) Aortic root replacement with composite valve graft. Ann Thorac Surg 76:90–98CrossRefPubMedGoogle Scholar
  17. 17.
    Slaughter MS, Jweied E (2007) Managing mechanical valves with reduced anticoagulation. Expert Rev Cardiovasc Ther 5:1073–1085CrossRefPubMedGoogle Scholar
  18. 18.
    Urbanski PP, Diegeler A, Siebel A, Zacher M, and Hacker RW (2003) Valved stentless composite graft: clinical outcomes and hemodynamic characteristics. Ann Thorac Surg 75:467–471CrossRefPubMedGoogle Scholar
  19. 19.
    Westaby S, Katsumata T, Vaccari G (1999) Coronary reimplantation in aortic root replacement: a method to avoid tension. Ann Thorac Surg 67:1176–1177CrossRefPubMedGoogle Scholar
  20. 20.
    Zehr KJ, Orszulak TA, Mullany CJ et al (2004) Surgery for aneurysms of aortic root. A 30-year experience. Circulation 110:1364–1371CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  • Davide Pacini
    • 1
  • R. Di Bartolomeo
  1. 1.Cardiac Surgery DepartmentUniversity of Bologna Policlinico S. Orsola-MalpighiBolognaItaly

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