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Influence of Valve Prosthesis Choice on the Results of Aortic Root Replacement: A Comparison Between Mechanical and Biological Valved Conduits

Ali Shahriari1, Hicham El-Masry1, Jo Mahenthiran2, Yousef Mahomed3, Mark Turrentine1, John W. Brown1.
1Indiana Aortic Disease Institute. Indiana University School of Medicine, Indianapolis, IN, USA, 2Community Heart and Vascular. The Indiana Heart Hospital, Indianapolis, IN, USA, 3Indiana University School of Medicine, Indianapolis, IN, USA.


Background:Aortic root replacement (ARR) is performed to treat aneurysmal disease of the aortic root and sometimes patients with small aortic annulus. Several studies have evaluated variable predictors of early and late morbidity and mortality of patients undergoing aortic valve replacement with mechanical and biological valve prosthesis. In this study we analyzed the influence of the choice of root prosthesis on the outcome of patients undergoing ARR.
Methods:Retrospective single center observational study of 420 patients who underwent aortic root replacement between March 1997 and July 2007. All patient who underwent ARR with mechanical or biological valved conduits were identified. Patients with connective tissue disorders were excluded from the analysis. A chart review was conducted. Endpoints were early and all cause-mortality, myocardial infarction, stroke, bleeding events, valve-related complications and renal failure. The mortality was tracked by analyzing the social security death index.
Results:130 patients underwent bioprosthetic (n=78) or mechanical (n=52) ARR. Baseline demographic and clinical characteristics (gender, concomitant CABG, hypertension, diabetes, atrial fibrillation, renal insufficiency, smoking status, LV dysfunction, bypass time) were similar in the two groups respectively except for age and incidence of lung disease significantly higher in the bioprosthetic valve group. The 30-day mortality was identical between the groups at 7.7%. Median follow up was 41±39 months. Comparison of outcomes revealed no significant differences between the 2 groups. On Cox regression analysis only age (p=0.037) and bypass time (p=0.007) predicted all cause mortality.
Conclusion:Patients undergoing ARR had similar short and intermediate-term outcomes. With similar comorbidities the long-term outcomes between the 2 groups was only dependent on the age difference. With improved durability of new generation bioprosthetic valves, we recommend biological valved conduits for patients over age 50 years whose aortic valves cannot be spared.
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