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Eur J Cardiothorac Surg 2001;20:252-256
© 2001 Elsevier Science NL

Composite stentless valve with graft extension for combined replacement of the aortic valve, root and ascending aorta

^a Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA
^b Division of Cardiac Anesthesia, Brigham and Women's Hospital, Boston, MA 02115, USA

Received 12 February 2001; received in revised form 9 May 2001; accepted 12 May 2001.

Corresponding author. Tel.: +1-617-732-7678; fax: +1-617-732-6559
e-mail: jbyrne{at}partners.org

Objective: The composite mechanical valve conduit has been most commonly used for patients who require combined aortic valve, root, and ascending aorta replacement, but is limited, especially in the elderly, because of the need for long-term anticoagulation. We report the first consecutive series of patients in whom a composite stentless valve with graft extension, which does not require long-term anticoagulation, was performed. Methods: Between April 1998 and July 2000, eight patients with severe aortic root and ascending aortic pathology underwent a combined aortic valve, root, and ascending aorta replacement with a Freestyle^® stentless porcine valve with a Hemashield^® graft extension. Mean age was 74 (range 56–82), three were males. Concomitant procedures included coronary artery bypass graft (CABG) alone (n=2), mitral valve replacement with atrial septal defect repair (n=1) and CABG with septal myomectomy (n=1). Results: Operative mortality was zero. Median aortic cross-clamp and cardiopulmonary bypass times were 150 and 203 min, respectively. Two patients returned to the operating room for bleeding. Median blood transfusions and hospital length of stay were 4 units and 11 days, respectively. Conclusions: The composite stentless valve with graft extension is a reasonable alternative to a mechanical valve conduit for patients who require a combined aortic valve, root, and ascending aorta replacement, in whom anticoagulation is not desirable or contraindicated.

Key Words: Freestyle • Aortic valve replacement • Ascending aortic aneurysm

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