HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Tirone E. David Christopher M. Feindel Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by David, T. E. Articles by Bos, J. Search for Related Content PubMed Articles by David, T. E. Articles by Bos, J. Related Collections Valve disease

J Thorac Cardiovasc Surg 2009;137:94-100
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Postimplantation morphologic changes of glutaraldehyde-fixed porcine aortic roots and risk of aneurysm and rupture

Division of Cardiovascular Surgery of the Peter Munk Cardiac Centre and the Department of Pathology of Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada

Received for publication March 4, 2008; revisions received June 24, 2008; accepted for publication July 2, 2008.

^_* Address for reprints: Tirone E. David, MD, 200 Elizabeth St 4N457, Toronto, Ontario M5G 2C4, Canada. (Email: tirone.david{at}uhn.on.ca).

Objective: Rupture of glutaraldehyde-fixed porcine aortic roots has been reported, but the mechanism and incidence of this complication is unknown. This study evaluates the clinical outcomes and the risk of dilation and rupture of porcine aortic roots after implantation.

Methods: Commercially available porcine aortic roots were used for aortic root replacement in 308 patients (Freestyle bioprosthesis [Medtronic, Minneapolis, Minn] in 251 patients and Toronto Root [St Jude Medical, St Paul, Minn] in 57 patients) whose mean age was 62 ± 13 years. The main indication for aortic root replacement was dilation of the native aortic root. Clinical follow-up was complete at a mean of 5.3 ± 2.5 years. Valve function and aortic root diameter were assessed by means of echocardiography.

Results: There were 10 (3.2%) operative and 39 (12.6%) late deaths. At 8 years, patients' survival was 79.0% ± 3.1%, freedom from reoperation was 95.3% ± 1.7%, and freedom from severe aortic insufficiency was 93.8% ± 2.7%. The diameter of the aortic sinuses increased from 31.9 ± 4.3 to 34.1 ± 4.8 mm (P < .0001), and it exceeded 40 mm in 10% of the patients. Linear regression analysis revealed that the duration of follow-up (P < .0001) and the size of the valve implanted (P < .0001) were associated with risk of sinus dilation. There was only 1 early rupture of the noncoronary aortic sinus and 2 late aneurysms that required repeat operations. Histologic examination of explanted aneurysmal porcine roots revealed marked changes in the xenograft arterial wall, with abundant mononuclear cells suggestive of immunologic reaction.

Conclusions: Mild dilation of porcine aortic roots after aortic root replacement is common, but aneurysm formation and rupture are rare during the first decade of follow-up. Annual surveillance with echocardiography is recommended.