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J Thorac Cardiovasc Surg 1999;118:1014-1020
© 1999 Mosby, Inc.

SURGERY FOR ACQUIRED CARDIOVASCULAR DISEASE

REPLACEMENT OF THE PROXIMAL AORTA AND AORTIC VALVE USING A COMPOSITE BILEAFLET PROSTHESIS AND GELATIN-IMPREGNATED POLYESTER GRAFT (CARBO-SEAL): EARLY RESULTS IN 143 PATIENTS

From the Wessex Cardiothoracic Centre,^a Southampton General Hospital, Southampton, United Kingdom, Cardiothoracic Surgical Unit,^b Queen Elizabeth Hospital, Edgbaston, Birmingham, United Kingdom, and Medical Statistics and Computing,^c University of Southampton, Southampton General Hospital, Southampton, United Kingdom.

Address for reprints: Stephen M. Langley, Wessex Cardiothoracic Centre, Southampton General Hospital, Southampton, United Kingdom, SO16 6YD (E-mail: StephenLangley{at}dial.pipex.com ).

Objective: We report the combined early results from two centers in the United Kingdom using a composite conduit consisting of a bileaflet mechanical valve incorporated into a gelatin-impregnated, ultra-low porosity, woven polyester graft (Carbo-Seal; Sulzer Carbomedics, Inc, Austin, Tex).
Methods: Between August 1992 and March 1997, 143 patients underwent aortic root replacement with the Carbo-Seal composite prosthesis. The indication for surgery was acute type A dissection in 31 (22%), chronic type A dissection in 9 (6%), ascending aortic aneurysm without dissection in 100 (70%), and false aneurysm of the ascending aorta in 3 (2%). Twenty-seven patients (19%) had undergone previous sternotomy, and 40 (28%) were seen as emergencies. Concomitant procedures were performed in 38 (27%), including 18 aortic arch or hemiarch replacements. Total follow-up is 270 patient-years. Follow-up is 100% complete.
Results: The early (30-day) mortality was 7% (10 patients). Permanent neurologic events occurred in 2%. At a mean follow-up of 23 months, 94% of survivors were in New York Heart Association functional class I. Freedom from reoperation was 97.2% ± 1.6% (1 standard error [1 SE]) at 12 months and 95.7% ± 2.2% at 48 months. Including early mortality, survival was 90.1% ± 2.6% at 12 months and 83.1% ± 3.5% at 48 months.
Conclusions: Aortic root replacement with use of the Carbo-Seal prosthesis can be undertaken with a relatively low early mortality and morbidity. A low reoperation rate and high intermediate-term survival can be expected, but continued follow-up is needed to determine the long-term efficacy of this prosthesis.

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