The Ticking Clock of Aortic Root Replacement - Single-Center Experience After Urgent and Emergent Aortic Root Replacement Using the BioIntegral and Freestyle™ Bioconduits.

Abstract

Introduction: Aortic root pathologies needing full aortic root replacement are challenging entities correlated to high morbidity and mortality due to their complexity and mostly refer to high-risk patients. In this retrospective study, we report our surgical experience and clinical results of patients undergoing a Bentall procedure as primary or reoperative surgery with the application of aortic bioconduits.

Methods: Patients who underwent full aortic root replacement utilizing either BioIntegral (BI) or Medtronic Freestyle™ (FS) bioconduit in the Cardiothoracic Surgery Department of the University Hospital Aachen RWTH from January 2015 until September 2020, in an urgent or emergency setting, were analyzed and followed up until December 2023.

Results: Twenty-six patients underwent aortic root replacement with bioconduits (N=11 with BI, N=15 with FS) in our center. Twenty-three cases were of infective cause, and three were of noninfective cause; 30.76% were urgent, and 69.23% were emergency cases. Two (7.70%) patients died during operation due to irreversible aortic root damage. In-hospital and 30-day mortality rates were four out 26 (15.4%) patients. The mean follow-up time for all the patients was 52.01 ± 39.41 months. Patients who received a primary aortic root replacement had significantly higher survival than redo cases. BI surgery needed longer cardiopulmonary bypass times.

Conclusion: Clinical outcome was equal for both bioconduits. Further studies with larger cohorts are needed for deeper insights into this complex entity.