Nimesh Desai MD, Fenton McCarthy, Wilson Szeto MD, Alberto Pochettino MD, Richard Erwin, Yasmin El-Sayed, Joseph Bavaria MD Thoracic Aortic Research Program.

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Presentation transcript:

Nimesh Desai MD, Fenton McCarthy, Wilson Szeto MD, Alberto Pochettino MD, Richard Erwin, Yasmin El-Sayed, Joseph Bavaria MD Thoracic Aortic Research Program University of Pennsylvania School of Medicine Philadelphia, PA

 Stentless porcine bioroots were developed as a root replacement that avoids anticoagulation  Concerns have been raised about porcine bioroots  Early structural valve deterioration  Increased complexity of reoperation  Renewed interest in pericardial valved composite roots  This study evaluates the hemodynamics of porcine bioroots and pericardial composite roots

 Evaluated all patients receiving either a porcine bioroot (St. Jude Toronto Root) or a pericardial composite root (CE pericardial model dacron graft)  Single institution from December 2001-June 2009  All root replacements performed for root pathology  Preoperative, postoperative and greater than one year follow-up echo data was compiled for all patients.  Median follow-up 3.0 years (range 1yr-6.5 yrs)  Patients with endocarditis or acute aortic dissections were excluded

Diagnosis Stentless Porcine Bioroot (n=81) Pericardial Composite Root (n=95) AI/Aneurys m 5249 AS512 Mixed AI/AS2316 Other1*4** TOTAL81 *Chronic Dissection **Dehisced AVRs [3], chronic dissection [1]

PREOPEREATIVELY : NO significant differences between the groups Porcine Bioroots (n=81) Mean +/- SD Pericardial Composite Roots (n=95) Mean +/- SD P value PREOP LVEF 58 +/ / AV peak 48 +/ / AV mean 29 +/ / LVEDD 6 +/ / LVESD 4 +/ / LVMI 135 +/ /

POSTOPERATIVELY : NO significant differences between the groups Porcine Bioroots (n=81) Mean +/- SD Pericardial Composite Roots (n=95) Mean +/- SD P value POSTOP LVEF 57 +/ / AV peak 17 +/ / AV mean 9 +/ / LVEDD 5 +/ / LVESD 3 +/ / LVMI 131 +/ /

Porcine Bioroots (n=81) Mean +/- SD Pericardial Composite Roots (n=95) Mean +/- SD P value > 1 YEAR LVEF 60 +/ / AV peak 13 +/ / AV mean 7 +/ / LVEDD 5 +/ / LVESD 3 +/ / LVMI 108 +/ /

 Porcine bioroots have lower gradients at greater than one year of follow-up  Gradients were low in both groups overall  Similar left ventricular remodeling as assessed by LV mass regression and LV diameters  Suggests pericardial roots are a viable alternative