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Root Replacement with Biological Valved Conduits

  • Paolo Berretta
  • Marco Di Eusanio
Chapter

Abstract

In 1968, Bentall and De Bono introduced the surgical technique involving composite aortic valve and root replacement with reimplantation of the coronary arteries for treatment of thoracic aortic aneurysms [1]. Since its introduction, Bentall procedure has proven to be a safe and effective technique [2–4], and has been considered the gold standard in the surgical treatment of combined aortic valve and root pathologies. As initially described by Bentall and De Bono, it involved the use of a composite mechanical valved conduit. However, the use of biological aortic valve prostheses has increased noticeably over the last years [5]. This trend may be due to the raising prevalence of aortic valve diseases in the elderly population [6], the growing data proving excellent long-term durability of latest aortic prostheses [7, 8], the need for long-term anticoagulation for mechanical valves [6, 9] and the development of minimally invasive transcatheter valve-in-valve techniques [10]. Together, these data have triggered the development of alternative biological root substitutes and techniques for aortic root replacement such as biological hand-sewn composite grafts, xenograft aortic bioprosthetic root and total biological valved conduit. Compared to mechanical composite grafts, these biological valved conduits do not require lifelong oral anticoagulation and are subsequently associated with a lower thromboembolic/haemorragic risk.

References

  1. 1.
    Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax. 1968;23:338–9.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Gleason TG, David TE, Coselli JS, Hammon JW, Bavaria JE. St. Jude Medical Toronto biologic aortic root prosthesis: early FDA phase II IDE study results. Ann Thorac Surg. 2004;78:786–93.CrossRefPubMedGoogle Scholar
  3. 3.
    Sioris T, David TE, Ivanov J, Armstrong S, Feindel CM. Clinical outcomes after separate and composite replacement of the aortic valve and ascending aorta. J Thorac Cardiovasc Surg. 2004;128:260–5.CrossRefPubMedGoogle Scholar
  4. 4.
    Zehr KJ, Orszulak TA, Mullany CJ, Matloobi A, Daly RC, Dearani JA, Sundt TM, Puga FJ, Danielson GK, Schaff HV. Surgery for aneurysms of the aortic root: a 30-year experience. Circulation. 2004;110:1364–71.CrossRefPubMedGoogle Scholar
  5. 5.
    Brown JM, O'Brien SM, Wu C, Sikora JA, Griffith BP, Gammie JS. Isolated aortic valve replacement in North America comprising 108,687 patients in 10 years: changes in risks, valve types, and outcomes in the Society of Thoracic Surgeons National Database. J Thorac Cardiovasc Surg. 2009;137:82–90.CrossRefPubMedGoogle Scholar
  6. 6.
    Authors/Task Force Members, Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schäfers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M, ESC Committee for Practice Guidelines (CPG), Bax JJ, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, Mcdonagh T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Reviewers D, Von Segesser L, Badano LP, Bunc M, Claeys MJ, Drinkovic N, Filippatos G, Habib G, Kappetein AP, Kassab R, Lip GY, Moat N, Nickenig G, Otto CM, Pepper J, Piazza N, Pieper PG, Rosenhek R, Shuka N, Schwammenthal E, Schwitter J, Mas PT, Trindade PT, Walther T. Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg. 2012;42:S1–S44.CrossRefGoogle Scholar
  7. 7.
    Forcillo J, Pellerin M, Perrault LP, Cartier R, Bouchard D, Demers P, Carrier M. Carpentier-Edwards pericardial valve in the aortic position: 25-years experience. Ann Thorac Surg. 2013;96:486–93.CrossRefPubMedGoogle Scholar
  8. 8.
    Bourguignon T, Bouquiaux-Stablo A, Candolfi P, Mirza A, Loardi C, May M, El-Khoury R, Marchand M, Aupart M. Very long-term outcomes of the Carpentier-Edwards perimount valve in aortic position. Ann Thorac Surg. 2015;99:831–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Slaughter MS, Jweied E. Managing mechanical valves with reduced anticoagulation. Expert Rev Cardiovasc Ther. 2007;5:1073–85.CrossRefPubMedGoogle Scholar
  10. 10.
    Thomas M, Schymik G, Walther T, Himbert D, Lefèvre T, Treede H, Eggebrecht H, Rubino P, Colombo A, Lange R, Schwarz RR, Wendler O. One-year outcomes of cohort 1 in the Edwards SAPIEN Aortic Bioprosthesis European Outcome (SOURCE) registry: the European registry of transcatheter aortic valve implantation using the Edwards SAPIEN valve. Circulation. 2011;124:425–33.CrossRefPubMedGoogle Scholar
  11. 11.
    Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE, Eagle KA, Hermann LK, Isselbacher EM, Kazerooni EA, Kouchoukos NT, Lytle BW, Milewicz DM, Reich DL, Sen S, Shinn JA, Svensson LG, Williams DM, Society for Vascular Medicine. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation. 2010;121:e266–369.CrossRefPubMedGoogle Scholar
  12. 12.
    Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RS, Vrints CJ, ESC Committee for Practice Guidelines. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35:2873–926.CrossRefPubMedGoogle Scholar
  13. 13.
    Jondeau G, Detaint D, Tubach F, Arnoult F, Milleron O, Raoux F, Delorme G, Mimoun L, Krapf L, Hamroun D. Aortic event rate in the Marfan population a cohort study. Circulation. 2012;125:226–32.CrossRefPubMedGoogle Scholar
  14. 14.
    Halstead JC, Spielvogel D, Meier DM, Rinke S, Bodian C, Malekan R, Ergin MA, Griepp RB. Composite aortic root replacement in acute type A dissection: time to rethink the indications? Eur J Cardiothorac Surg. 2005;27:626–32. discussion 632-3.CrossRefPubMedGoogle Scholar
  15. 15.
    Kallenbach K, Oelze T, Salcher R, Hagl C, Karck M, Leyh RG, Haverich A. Evolving strategies for treatment of acute aortic dissection type A. Circulation. 2004;110:II–243.CrossRefGoogle Scholar
  16. 16.
    Westaby S, Saito S, Katsumata T. Acute type A dissection: conservative methods provide consistently low mortality. Ann Thorac Surg. 2002;73:707–13.CrossRefPubMedGoogle Scholar
  17. 17.
    Di Eusanio M, Trimarchi S, Peterson MD, Myrmel T, Hughes GC, Korach A, Sundt TM, Di Bartolomeo R, Greason K, Khoynezhad A, Appoo JJ, Folesani G, De Vincentiis C, Montgomery DG, Isselbacher EM, Eagle KA, Nienaber CA, Patel HJ. Root replacement surgery versus more conservative management during type A acute aortic dissection repair. Ann Thorac Surg. 2014;98:2078–84.CrossRefPubMedGoogle Scholar
  18. 18.
    Castrovinci S, Pacini D, Di Marco L, Berretta P, Cefarelli M, Murana G, Alfonsi J, Pantaleo A, Leone A, Di Eusanio M, Di Bartolomeo R. Surgical management of aortic root in type A acute aortic dissection: a propensity-score analysis†. Eur J Cardiothorac Surg. 2016;50(2):223–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Del Zotti F, Dulgheru R, El Khoury G, Erba PA, Iung B, Miro JM, Mulder BJ, Plonska-Gosciniak E, Price S, Roos-Hesselink J, Snygg-Martin U, Thuny F, Tornos Mas P, Vilacosta I, Zamorano JL, Erol Ç, Nihoyannopoulos P, Aboyans V, Agewall S, Athanassopoulos G, Aytekin S, Benzer W, Bueno H, Broekhuizen L, Carerj S, Cosyns B, De Backer J, De Bonis M, Dimopoulos K, Donal E, Drexel H, Flachskampf FA, Hall R, Halvorsen S, Hoen B, Kirchhof P, Lainscak M, Leite-Moreira AF, Lip GY, Mestres CA, Piepoli MF, Punjabi PP, Rapezzi C, Rosenhek R, Siebens K, Tamargo J, Walker DM. 2015 ESC Guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J. 2015;36:3075–128.CrossRefPubMedGoogle Scholar
  20. 20.
    Knosalla C. Surgical treatment of active infective aortic valve endocarditis with associated periannular abscess—11 year results. Eur Heart J. 2000;21:490–7.CrossRefPubMedGoogle Scholar
  21. 21.
    d'Udekem Y, David TE, Feindel CM, Armstrong S, Sun Z. Long-term results of operation for paravalvular abscess. Ann Thorac Surg. 1996;62:48–53.CrossRefPubMedGoogle Scholar
  22. 22.
    Moon MR, Miller DC, Moore KA, Oyer PE, Mitchell RS, Robbins RC, Stinson EB, Shumway NE, Reitz BA. Treatment of endocarditis with valve replacement: the question of tissue versus mechanical prosthesis. Ann Thorac Surg. 2001;71:1164–71.CrossRefPubMedGoogle Scholar
  23. 23.
    Perrotta S, Jeppsson A, Fröjd V, Svensson G. Surgical treatment for infective endocarditis: a single-centre experience. Thorac Cardiovasc Surg. 2016;25(3):169–73.Google Scholar
  24. 24.
    Watanabe G, Haverich A, Speier R, Dresler C, Borst HG. Surgical treatment of active infective endocarditis with paravalvular involvement. J Thorac Cardiovasc Surg. 1994;107:171–7.PubMedGoogle Scholar
  25. 25.
    Kirali K, Sarikaya S, Ozen Y, Sacli H, Basaran E, Yerlikhan OA, Aydin E, Rabus MB. Surgery for aortic root abscess: a 15-year experience. Tex Heart Inst J. 2016;43:20–8.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Dossche KM, Defauw JJ, Ernst SM, Craenen TW, De Jongh BM, de la Rivière AB. Allograft aortic root replacement in prosthetic aortic valve endocarditis: a review of 32 patients. Ann Thorac Surg. 1997;63:1644–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Glazier JJ, Verwilghen J, Donaldson RM, Ross DN. Treatment of complicated prosthetic aortic valve endocarditis with annular abscess formation by homograft aortic root replacement. J Am Coll Cardiol. 1991;17:1177–82.CrossRefPubMedGoogle Scholar
  28. 28.
    Joyce F, Tingleff J, Aagaard J, Pettersson G. The Ross operation in the treatment of native and prosthetic aortic valve endocarditis. J Heart Valve Dis. 1994;3:371–6.PubMedGoogle Scholar
  29. 29.
    Niwaya K, Knott-Craig CJ, Santangelo K, Lane MM, Chandrasekaran K, Elkins RC. Advantage of autograft and homograft valve replacement for complex aortic valve endocarditis. Ann Thorac Surg. 1999;67:1603–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Aagaard J, Andersen PV. Acute endocarditis treated with radical debridement and implantation of mechanical or stented bioprosthetic devices. Ann Thorac Surg. 2001;71:100–3.CrossRefPubMedGoogle Scholar
  31. 31.
    Aoyagi S, Fukunaga S, Tayama E, Hayashida N, Kawara T. Surgical treatment of prosthetic valve endocarditis with left ventricular-aortic discontinuity: reconstruction of the left ventricular outflow tract with a xenopericardial conduit. J Heart Valve Dis. 2001;10:367–70.PubMedGoogle Scholar
  32. 32.
    Musci M, Weng Y, Hübler M, Amiri A, Pasic M, Kosky S, Stein J, Siniawski H, Hetzer R. Homograft aortic root replacement in native or prosthetic active infective endocarditis: twenty-year single-center experience. J Thorac Cardiovasc Surg. 2010;139:665–73.CrossRefPubMedGoogle Scholar
  33. 33.
    Pagano D, Allen SM, Bonser RS. Homograft aortic valve and root replacement for severe destructive native or prosthetic endocarditis. Eur J Cardiothorac Surg. 1994;8:173–6.CrossRefPubMedGoogle Scholar
  34. 34.
    Avierinos J-F, Thuny F, Chalvignac V, Giorgi R, Tafanelli L, Casalta J-P, Raoult D, Mesana T, Collart F, Metras D. Surgical treatment of active aortic endocarditis: homografts are not the cornerstone of outcome. Ann Thorac Surg. 2007;84:1935–42.CrossRefPubMedGoogle Scholar
  35. 35.
    David TE. Aortic valve repair for active infective endocarditis. Eur J Cardiothorac Surg. 2012;42(1):127–8. ezr283CrossRefPubMedGoogle Scholar
  36. 36.
    Di Eusanio M, Castrovinci S, Cefarelli M, Berretta P, Alfonsi J, Murana G, Di Bartolomeo R. Minimally invasive root surgery: a Bentall procedure through a J-ministernotomy. Ann Cardiothorac Surg. 2015;4:198–200.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Di Eusanio M, Pucci A, and Berretta P. Mini-Bentall Procedure with Mitroflow Valsalva Conduit. CTSNet. http://www.ctsnet.org/article/mini-bentall-procedure-mitroflow-valsalva-conduit. Published April 18, 2016.
  38. 38.
    Kouchoukos NT, Karp RB. Resection of ascending aortic aneurysm and replacement of aortic valve. J Thorac Cardiovasc Surg. 1981;81:142–3.PubMedGoogle Scholar
  39. 39.
    Copeland JG, Rosado LJ, Snyder SL. New technique for improving hemostasis in aortic root replacement with composite graft. Ann Thorac Surg. 1993;55:1027–9.CrossRefPubMedGoogle Scholar
  40. 40.
    Urbanski PP, Hacker RW. Replacement of the aortic valve and ascending aorta with a valved stentless composite graft: technical considerations and early clinical results. Ann Thorac Surg. 2000;70:17–20.CrossRefPubMedGoogle Scholar
  41. 41.
    Tabata M, Takayama H, Bowdish ME, Smith CR, Stewart AS. Modified Bentall operation with bioprosthetic valved conduit: Columbia University experience. Ann Thorac Surg. 2009;87:1969–70.CrossRefPubMedGoogle Scholar
  42. 42.
    Albertini A, Dell'Amore A, Zussa C, Lamarra M. Modified Bentall operation: the double sewing ring technique. Eur J Cardiothorac Surg. 2007;32:804–6.CrossRefPubMedGoogle Scholar
  43. 43.
    Urbanski PP, Heinz N, Zhan X, Hijazi H, Zacher M, Diegeler A. Modified bio-Bentall procedure: 10-year experience. Eur J Cardiothorac Surg. 2010;37:1317–21.CrossRefPubMedGoogle Scholar
  44. 44.
    Doty DB, Cafferty A, Kon ND, Huysmans HA, Krause AH, Westaby S. Medtronic freestyle aortic root bioprosthesis: implant techniques. J Card Surg. 1998;13:369–75.CrossRefPubMedGoogle Scholar
  45. 45.
    Westaby S, Amarasena N, Ormerod O, Amarasena GA, Pillai R. Aortic valve replacement with the freestyle stentless xenograft. Ann Thorac Surg. 1995;60:S422–7.CrossRefPubMedGoogle Scholar
  46. 46.
    Abolhoda A, Yu S, Oyarzun JR, Allen KR, McCormick JR, Han S, Kemp FW, Bogden JD, Lu Q, Gabbay S. No-react detoxification process: a superior anticalcification method for bioprostheses. Ann Thorac Surg. 1996;62:1724–30.CrossRefPubMedGoogle Scholar
  47. 47.
    Müller LC, Chevtchik O, Bonatti JO, Müller S, Fille M, Laufer G. Treatment of destructive aortic valve endocarditis with the freestyle aortic root bioprosthesis. Ann Thorac Surg. 2003;75:453–6.CrossRefPubMedGoogle Scholar
  48. 48.
    Musci M, Siniawski H, Knosalla C, Grauhan O, Weng Y, Pasic M, Meyer R, Hetzer R. Early and mid-term results of the Shelhigh stentless bioprosthesis in patients with active infective endocarditis. Clin Res Cardiol. 2006;95:247–53.CrossRefPubMedGoogle Scholar
  49. 49.
    Doty DB, Cafferty A, Cartier P, Huysmans HA, Kon ND, Krause AH, Millar RC, Sintek CF, Westaby S. Aortic valve replacement with medtronic freestyle bioprosthesis: 5-year results. In: Seminars in thoracic and cardiovascular surgery. p. 35–41;1999.Google Scholar
  50. 50.
    Galiñanes M, Meduoye A, Ferreira I, Sosnowski A. Totally biological composite aortic stentless valved conduit for aortic root replacement: 10-year experience. J Cardiothorac Surg. 2011;6:86.CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Carrel TP, Schoenhoff FS, Schmidli J, Stalder M, Eckstein FS, Englberger L. Deleterious outcome of no-react-treated stentless valved conduits after aortic root replacement: why were warnings ignored? J Thorac Cardiovasc Surg. 2008;136:52–7.CrossRefPubMedGoogle Scholar
  52. 52.
    Sahin A, Müggler O, Sromicki J, Caliskan E, Reser D, Emmert MY, Alkadhi H, Maisano F, Falk V, Holubec T. Long-term follow-up after aortic root replacement with the Shelhigh® biological valved conduit: a word of caution! Eur J Cardiothorac Surg. 2016;50(6):1172–8.CrossRefPubMedGoogle Scholar
  53. 53.
    Reineke DC, Kaya A, Heinisch PP, Oezdemir B, Winkler B, Huber C, Heijmen RH, Morshuis W, Carrel TP, Englberger L. Long-term follow-up after implantation of the Shelhigh® No-React® complete biological aortic valved conduit. Eur J Cardiothorac Surg. 2016;50:98–104.CrossRefPubMedGoogle Scholar
  54. 54.
    Castrovinci S, Tian DH, Murana G, Cefarelli M, Berretta P, Alfonsi J, Yan TD, Di Bartolomeo R, Di Eusanio M. Aortic root replacement with biological valved conduits. Ann Thorac Surg. 2015;100:37–53.CrossRefGoogle Scholar
  55. 55.
    Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD, American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:e57–185.CrossRefPubMedGoogle Scholar
  56. 56.
    Naji P, Griffin BP, Sabik JF, Kusunose K, Asfahan F, Popovic ZB, Rodriguez LL, Lytle BW, Grimm RA, Svensson LG, Desai MY. Characteristics and outcomes of patients with severe bioprosthetic aortic valve stenosis undergoing redo surgical aortic valve replacement. Circulation. 2015;132:1953–60.CrossRefPubMedGoogle Scholar
  57. 57.
    Di Eusanio M, Fortuna D, De Palma R, Dell'Amore A, Lamarra M, Contini GA, Gherli T, Gabbieri D, Ghidoni I, Cristell D, Zussa C, Pigini F, Pugliese P, Pacini D, Di Bartolomeo R. Aortic valve replacement: results and predictors of mortality from a contemporary series of 2256 patients. J Thorac Cardiovasc Surg. 2011;141:940–7.CrossRefPubMedGoogle Scholar
  58. 58.
    Siregar S, de Heer F, Groenwold RH, Versteegh MI, Bekkers JA, Brinkman ES, Bots ML, van der Graaf Y, van Herwerden LA. Trends and outcomes of valve surgery: 16-year results of Netherlands Cardiac Surgery National Database. Eur J Cardiothorac Surg. 2014;46:386–97. discussion 397.CrossRefPubMedGoogle Scholar
  59. 59.
    Stamou SC, Williams ML, Gunn TM, Hagberg RC, Lobdell KW, Kouchoukos NT. Aortic root surgery in the United States: a report from the Society of Thoracic Surgeons database. J Thorac Cardiovasc Surg. 2015;149:116–22.e4.CrossRefPubMedGoogle Scholar
  60. 60.
    Svensson LG, Pillai ST, Rajeswaran J, Desai MY, Griffin B, Grimm R, Hammer DF, Thamilarasan M, Roselli EE, Pettersson GB, Gillinov AM, Navia JL, Smedira NG, Sabik JF, Lytle BW, Blackstone EH. Long-term survival, valve durability, and reoperation for 4 aortic root procedures combined with ascending aorta replacement. J Thorac Cardiovasc Surg. 2016;151:764–774.e4.CrossRefPubMedGoogle Scholar
  61. 61.
    David TE, Feindel CM, David CM, Manlhiot C. A quarter of a century of experience with aortic valve-sparing operations. J Thorac Cardiovasc Surg. 2014;148:872–80.CrossRefPubMedGoogle Scholar
  62. 62.
    Oka T, Okita Y, Matsumori M, Okada K, Minami H, Munakata H, Inoue T, Tanaka A, Sakamoto T, Omura A. Aortic regurgitation after valve-sparing aortic root replacement: modes of failure. Ann Thorac Surg. 2011;92:1639–44.CrossRefPubMedGoogle Scholar
  63. 63.
    Etz CD, Homann TM, Rane N, Bodian CA, Di Luozzo G, Plestis KA, Spielvogel D, Griepp RB. Aortic root reconstruction with a bioprosthetic valved conduit: a consecutive series of 275 procedures. J Thorac Cardiovasc Surg. 2007;133:1455–63.CrossRefPubMedGoogle Scholar
  64. 64.
    LeMaire SA, Green SY, Sharma K, Cheung CK, Sameri A, Tsai PI, Adams G, Coselli JS. Aortic root replacement with stentless porcine xenografts: early and late outcomes in 132 patients. Ann Thorac Surg. 2009;87:503–12. discussion 512-3.CrossRefPubMedGoogle Scholar
  65. 65.
    Dapunt OE, Easo J, Hölzl PP, Murin P, Südkamp M, Horst M, Natour E. Stentless full root bioprosthesis in surgery for complex aortic valve-ascending aortic disease: a single center experience of over 300 patients. Eur J Cardiothorac Surg. 2008;33:554–9.CrossRefPubMedGoogle Scholar
  66. 66.
    Kon ND, Riley RD, Adair SM, Kitzman DW, Cordell AR. Eight-year results of aortic root replacement with the freestyle stentless porcine aortic root bioprosthesis. Ann Thorac Surg. 2002;73:1817–21. discussion 1821.CrossRefPubMedGoogle Scholar
  67. 67.
    Mohammadi S, Baillot R, Voisine P, Mathieu P, Dagenais F. Structural deterioration of the freestyle aortic valve: mode of presentation and mechanisms. J Thorac Cardiovasc Surg. 2006;132:401–6.CrossRefPubMedGoogle Scholar
  68. 68.
    Kappetein AP, Braun J, Baur LH, Prat A, Peels K, Hazekamp MG, Schoof PH, Huysmans HA. Outcome and follow-up of aortic valve replacement with the freestyle stentless bioprosthesis. Ann Thorac Surg. 2001;71:601–8.CrossRefPubMedGoogle Scholar
  69. 69.
    Deleuze PH, Fromes Y, Khoury W, Maribas P, Lemaire S, Bical OM. Eight-year results of freestyle stentless bioprosthesis in the aortic position: a single-center study of 500 patients. J Heart Valve Dis. 2006;15:247–52.PubMedGoogle Scholar
  70. 70.
    Cartier PC, Dumesnil JG, Métras J, Desaulniers D, Doyle DP, Lemieux MD, Raymond G. Clinical and hemodynamic performance of the freestyle aortic root bioprosthesis. Ann Thorac Surg. 1999;67:345–9.CrossRefPubMedGoogle Scholar
  71. 71.
    Bach DS, Metras J, Doty JR, Yun KL, Dumesnil JG, Kon ND. Freedom from structural valve deterioration among patients aged < or = 60 years undergoing freestyle stentless aortic valve replacement. J Heart Valve Dis. 2007;16:649–55. discussion 656.PubMedGoogle Scholar
  72. 72.
    Akar AR, Szafranek A, Alexiou C, Janas R, Jasinski MJ, Swanevelder J, Sosnowski AW. Use of stentless xenografts in the aortic position: determinants of early and late outcome. Ann Thorac Surg. 2002;74:1450–7.CrossRefPubMedGoogle Scholar
  73. 73.
    Mookhoek A, Korteland NM, Arabkhani B, Di Centa I, Lansac E, Bekkers JA, Bogers AJ, Takkenberg JJ. Bentall procedure: a systematic review and meta-analysis. Ann Thorac Surg. 2016;101:1684–9.CrossRefPubMedGoogle Scholar
  74. 74.
    Berretta P, Di Marco L, Pacini D, Cefarelli M, Alfonsi J, Castrovinci S, Di Eusanio M, Di Bartolomeo R. Reoperations versus primary operation on the aortic root: a propensity score analysis. Eur J Cardiothorac Surg. 2016;51(2):322–8.Google Scholar
  75. 75.
    Di Bartolomeo R, Berretta P, Petridis FD, Folesani G, Cefarelli M, Di Marco L, Di Eusanio M. Reoperative surgery on the thoracic aorta. J Thorac Cardiovasc Surg. 2013;145(3 Suppl):S78–84.CrossRefPubMedGoogle Scholar
  76. 76.
    Etz CD, Bischoff MS, Bodian C, Roder F, Brenner R, Griepp RB, Di Luozzo G. The Bentall procedure: is it the gold standard? A series of 597 consecutive cases. J Thorac Cardiovasc Surg. 2010;140:S64–70. discussion S86–91.CrossRefPubMedGoogle Scholar
  77. 77.
    Khaladj N, Leyh R, Shrestha M, Peterss S, Haverich A, Hagl C. Aortic root surgery in septuagenarians: impact of different surgical techniques. J Cardiothorac Surg. 2009;4:1.CrossRefGoogle Scholar
  78. 78.
    Sorabella RA, Wu YS, Bader A, Kim MJ, Smith CR, Takayama H, Borger MA, George I. Aortic root replacement in octogenarians offers acceptable perioperative and late outcomes. Ann Thorac Surg. 2016;101:967–72.CrossRefPubMedGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Cardiac Surgery UnitOspedali RiunitiAnconaItaly

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