Aortic root replacement with stentless porcine xenografts: early and late outcomes in 132 patients

Ann Thorac Surg. 2009 Feb;87(2):503-12; discussion 512-3. doi: 10.1016/j.athoracsur.2008.11.033.


Background: Traditionally, aortic root replacement has most commonly involved mechanical composite valve grafts, which have excellent durability but necessitate lifelong anticoagulation. Stentless porcine xenografts (bioroots) are a recently developed alternative that enable root replacement without the necessity of long-term anticoagulation. This study examined the early and late outcomes of aortic root replacement with porcine bioroots.

Methods: Porcine bioroots were used for root replacement in 132 patients. Of these, 129 (97.7%) required graft extensions for ascending aortic replacement, and 55 (41.7%) underwent aortic arch replacement. Twenty-three operations (17.4%) were reoperations. Twenty-four patients (18.2%) had aortic dissection. Early and late outcomes were ascertained by reviewing medical records. Changes in New York Heart Association (NYHA) class were used to assess improvements in functional status. Follow-up echocardiography results were reviewed to assess bioprosthetic valve function and changes in left ventricular ejection fraction.

Results: There were 10 operative deaths (7.6%), 9 of which were directly related to intraoperative ventricular failure. Nine patients (6.8%) had late valve-related complications, including 5 patients with prosthetic endocarditis (3 died), 1 annular pseudoaneurysm, and 3 sudden, unexplained deaths. Survivors' NYHA status and left ventricular ejection fraction improved significantly. No structural valve dysfunction was evident during follow-up. Actuarial survival was 85.6% +/- 3.1% at 1 year and 77.8% +/- 4.8% at 5 years.

Conclusions: Aortic root replacement with porcine xenografts can be performed with respectable early and late outcomes, even when combined with aortic arch replacement. Further follow-up is necessary to evaluate long-term bioroot durability.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Animals
  • Aorta, Thoracic / surgery*
  • Aortic Aneurysm, Thoracic / diagnostic imaging
  • Aortic Aneurysm, Thoracic / mortality
  • Aortic Aneurysm, Thoracic / surgery*
  • Aortic Dissection / diagnostic imaging
  • Aortic Dissection / mortality
  • Aortic Dissection / surgery*
  • Blood Vessel Prosthesis Implantation / adverse effects
  • Blood Vessel Prosthesis Implantation / methods*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications / mortality
  • Probability
  • Prognosis
  • Prosthesis Design
  • Prosthesis Failure
  • Radiography
  • Reoperation
  • Risk Assessment
  • Survival Rate
  • Swine
  • Transplantation, Heterologous / methods*
  • Treatment Outcome
  • Young Adult