Background: The clinical value of root replacement with Freestyle® stentless porcine bioprosthesis in the treatment of ascending aortic aneurysm with aortic valvular disease is assessed in regard to early and mid-term results.
Methods: Eighteen consecutive patients (13 male / 5 female) underwent elective stentless porcine aortic root implantation. Mean age was 52 ± 14 years. Seven patients were in NYHA class II, another 7 in class III, and 4 in class IV. Average ascending aortic diameter was 61 ± 7 mm (range 50 to 80 mm) with severe aortic regurgitation in all cases. The average left ventricular end systolic diameter (LVESD) was 44 ± 1 4 mm, end diastolic diameter (LVEDD) was 60 ± 14 mm, septal thickness (IVST) was 16 ± 2 mm and ejection fraction (LVEF) was 58% ± 8%.
Results: The operative mortality was 11%. An ejection fraction less than 55% (p = 0.03), an aortic clamping time exceeding 90 minutes (p = 0.04), and bicuspid aortic stenosis (p = 0.03) were the mortality predictors. Survivors were followed for an average period of 24 ± 3 months, a total of 227 months. All were in NYHA class I and free from reoperation or valve-related events as of their last follow-up. The average peak trans aortic systolic gradiyent was 9 ± 4 mmHg, LVESD regressed to 37 ± 6 mm (p = 0.04), LVEDD to 56 ± 4 mm (p = 0.04), and IVST to 10 ± 3 mm (p = 0.02); LVEF was increased to 60% ± 12% (p = 0.05) at the first postoperative year. Kaplan-Meier survival estimate was 88% ± 8% at 2 years, including operative mortality.
Conclusions: These data establish that the stentless porcine aortic root replacement provides a reasonable surgical option for ascending aortic aneurysms necessitating aortic valve replacement. It may be the treatment of choice in the elderly, in mycotic aneurysms and where anticoagulation is not desirable, hence, should be included in the cardiovascular surgeon’s armamentarium. However, their durability must be evaluated with long-term studies.

Keywords : Aneurysm, stentless, bioprosthesis, ascending aorta