Aortic root replacement with a mechanical valve conduit: A single-institutional experience.

Abstract

Background: There is a lack of consensus regarding the best strategy for aortic root replacement with current guidelines supporting the use of mechanical valves in younger patients when a valve repair is not possible. We sought to describe our institutional experience with mechanical aortic root replacement.

Methods: This was a descriptive study using an institutional database of aortic root replacements with a mechanical valve composite graft performed at our center from 2010 to 2022. All patients undergoing aortic root replacements with a mechanical valve were included. Patients undergoing concomitant operations were also included and descriptive statistics were reported.

Results: A total of 217 patients underwent aortic root replacement with a mechanical valve of which women comprised 26.3 %. Bicuspid aortic valves were present in 30.41 % of patients. Aortic dissection and aneurysm were observed in 20.3 % and 35.5 % of patients, respectively, while moderate to severe aortic insufficiency was seen in 62.67 % of patients. Concomitant surgeries included coronary artery bypass graft surgery in 18 % and mitral valve replacement in 7.8 % of patients. Postoperatively, 18 % of patients required prolonged ventilation, while 3.7 % and 3.2 % had postoperative stroke or required dialysis, respectively. Reoperation for mediastinal bleeding was undertaken in 12.4 % of patients. Aortic reintervention over the period of the study was needed in eight patients (3.7 %). The operative/30-day mortality was 6.9 %. Mortality was 17.5 % at a median follow-up of 4 years (1.6-6.1).

Conclusion: Mechanical aortic root replacement is a relatively safe procedure for aortic root pathology with institutional outcomes comparable to other centers.