Postimplantation morphologic changes of glutaraldehyde-fixed porcine aortic roots and risk of aneurysm and rupture Tirone E. David, MD, Susan Armstrong,

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Postimplantation morphologic changes of glutaraldehyde-fixed porcine aortic roots and risk of aneurysm and rupture Tirone E. David, MD, Susan Armstrong, MSc, Manjula Maganti, MSc, Jagdish Butany, MD, Christopher M. Feindel, MD, Joanne Bos, RN The Journal of Thoracic and Cardiovascular Surgery Volume 137, Issue 1, Pages 94-100 (January 2009) DOI: 10.1016/j.jtcvs.2008.07.004 Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Survival after aortic root replacement with porcine aortic roots. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 94-100DOI: (10.1016/j.jtcvs.2008.07.004) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Freedom from reoperation. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 94-100DOI: (10.1016/j.jtcvs.2008.07.004) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Freedom from severe aortic insufficiency. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 94-100DOI: (10.1016/j.jtcvs.2008.07.004) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Changes in diameter of the aortic sinuses during follow-up. Zero indicates early postoperative diameters. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 94-100DOI: (10.1016/j.jtcvs.2008.07.004) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Changes in diameter in 20 patients with aortic sinuses of greater than 40 mm during follow-up. The Journal of Thoracic and Cardiovascular Surgery 2009 137, 94-100DOI: (10.1016/j.jtcvs.2008.07.004) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Left, This longitudinal section from an explanted Freestyle bioprosthesis shows the porcine aorta (P), the host aorta (H), and connective tissue deposited between the two. The porcine aorta shows multifocal destruction (“digestion”) of tissue and replacement with connective tissue (∗). Inflammatory cells are still present in the junctional areas between the porcine aortic media and the connective tissue (arrows). A thick layer of host tissue reaction is seen overlying the anastomosis of the porcine aorta with the host aorta. (Movat Pentachrome stain; original magnification, ×16.) Right, A section of porcine aorta (P) from an explanted Freestyle valve showing destruction of the media (arrows) and replacement by loose connective tissue. Inflammatory cells are seen in the junctional area. (Movat Pentachrome stain; original magnification ×100). The Journal of Thoracic and Cardiovascular Surgery 2009 137, 94-100DOI: (10.1016/j.jtcvs.2008.07.004) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions