Aortic Root Replacement With Biological Valved Conduits
2015; Elsevier BV; Volume: 100; Issue: 1 Linguagem: Inglês
10.1016/j.athoracsur.2015.02.057
ISSN1552-6259
AutoresSebastiano Castrovinci, David H. Tian, Giacomo Murana, Mariano Cefarelli, Paolo Berretta, Jacopo Alfonsi, Tristan D. Yan, Roberto Di Bartolomeo, Marco Di Eusanio,
Tópico(s)Infective Endocarditis Diagnosis and Management
ResumoThe execution of Bentall procedures using biological valved conduits is expanding owing to the increased incidence of aortic valve and root diseases in the aging population. To review the available data, a systematic search identified 29 studies with a total of 3,298 patients. Although evidence on short-term results suggested favorable outcomes after biological Bentall operations, data beyond 5 years are limited and highlight the urgent need for further investigations with longer follow-up. The execution of Bentall procedures using biological valved conduits is expanding owing to the increased incidence of aortic valve and root diseases in the aging population. To review the available data, a systematic search identified 29 studies with a total of 3,298 patients. Although evidence on short-term results suggested favorable outcomes after biological Bentall operations, data beyond 5 years are limited and highlight the urgent need for further investigations with longer follow-up. In 1968, Bentall and DeBono [1Bentall H. De Bono A. A technique for complete replacement of the ascending aorta.Thorax. 1968; 23: 338-339Crossref PubMed Scopus (1112) Google Scholar] first described the technique for complete replacement of the ascending aorta and aortic valve with the reimplantation of the coronary arteries. Since its introduction, this technique, which subsequently became known as the Bentall operation, has been considered the gold standard in the surgical treatment of combined aortic valve and ascending aorta diseases. The increasing age of patients currently requiring aortic root surgery and excellent long-term durability of newer biological aortic valve prostheses have stimulated an increase in the use of biological valved conduits, such as biological hand-sewn composite grafts, total biological root prostheses, and allografts. Despite this, data on biological Bentall procedures are sparse. The present systematic review aimed to evaluate early and late clinical outcomes after Bentall operations using biological valved conduits. Electronic searches were performed using PubMed, from the date of inception to February 2014. To achieve the maximum sensitivity of the search strategy and identify all studies, we combined the following terms: "aortic diseases/surgery" [Mesh] AND Bentall [Title] OR stented bioprosthetic valved conduit [Title] OR biological [Title] OR root bioprosthesis [Title] OR biological valved conduit [Title] OR biological root [Title] OR composite graft [Title] AND English [Language]." The reference lists of all retrieved articles were reviewed for further identification of potentially relevant studies. All identified articles were systematically assessed using the inclusion and exclusion criteria. Eligible studies for the present systematic review included those in which patient cohorts underwent Bentall procedures with biological prostheses. Primary end points included in-hospital (or 30 days) mortality, stroke, renal failure, respiratory failure, myocardial infarction, as well as follow-up survival, freedom from aortic reintervention, freedom from thromboembolic events, and freedom from prosthesis endocarditis. Studies that did not include predetermined primary or secondary end points were excluded. When institutions published duplicate studies with accumulating numbers of patients or increased lengths of follow-up, only the most complete reports were included for quantitative assessment at each time interval. All publications were limited to those involving human subjects and reported in the English language. Abstracts, case reports, conference presentations, editorials, and expert opinions were excluded. Review articles were omitted because of potential publication bias and duplication of results. All data were extracted from article texts, tables, and figures and subsequently tabulated by three of the investigators (S.C., G.M., M.C.). Data were reviewed by another investigator (D.H.T.). Discrepancies between the reviewers were resolved by discussion and consensus. The final results were reviewed by the senior investigator (M.D.E.). The quality of studies was assessed using criteria recommended by the National Health Service Centre for Reviews and Dissemination case series quality assessment criteria (University of York, UK) [2Centre for Reviews and Dissemination, University of YorkUndertaking systematic reviews of research on effectiveness: CRD's guidance for those carrying out or commissioning reviews. Research Report. CRD Report (4 (2nd ed)). NHS Centre for Reviews and Dissemination, York, UK2001Google Scholar]. Standard descriptive statistics were used to summarize demographic and baseline data of eligible patients. Data were presented as N (%) or mean ± standard deviation as appropriate. Pooled averages were estimated using the random-effects model as proposed by DerSimonian and Laird [3DerSimonian R. Laird N. Meta-analysis in clinical trials.Control Clin Trials. 1986; 7: 177-188Abstract Full Text PDF PubMed Scopus (28689) Google Scholar]. Pooled values were calculated when results were reported by at least 50% of studies and at least 50% of patients. The method of Hozo and colleagues [4Hozo S.P. Djulbegovic B. Hozo I. Estimating the mean and variance from the median, range, and the size of a sample.BMC Med Res Methodol. 2005; 5: 13Crossref PubMed Scopus (5298) Google Scholar] was used to estimate the mean and variance in studies that only reported median and range. Individual patient survival data were reconstructed using an iterative algorithm that was applied to solve the Kaplan-Meier equations originally used to produce the published graphs. This algorithm, as provided by Guyot and colleagues [5Guyot P. Ades A.E. Ouwens M.J. Welton N.J. Enhanced secondary analysis of survival data: reconstructing the data from published Kaplan-Meier survival curves.BMC Med Res Methodol. 2012; 12: 9Crossref PubMed Scopus (936) Google Scholar], uses digitalized Kaplan-Meier curve data to find numerical solutions to the inverted Kaplan-Meier equations. This algorithm assumed constant censoring (ie, that the censoring mechanism was noninformative), and was implemented in R (v.3.1.0). The reconstructed patient survival data for each study were then aggregated to form combined survival curves. Mixed effects meta-regression was conducted against outcomes on study-level variables. Evidence of publication bias was sought using the methods of Egger and associates [6Egger M. Davey Smith G. Schneider M. Minder C. Bias in meta-analysis detected by a simple, graphical test.BMJ. 1997; 315: 629-634Crossref PubMed Scopus (33691) Google Scholar] and Begg and Mazumdar [7Begg C.B. Mazumdar M. Operating characteristics of a rank correlation test for publication bias.Biometrics. 1994; 50: 1088-1101Crossref PubMed Scopus (11705) Google Scholar]. If studies appear to be missing in areas of low statistical significance, then it is possible that the asymmetry is a result of publication bias. If studies appear to be missing in areas of high statistical significance, then publication bias is a less likely cause of funnel asymmetry. Intercept significance was determined by the Student's t test suggested by Egger and associates [6Egger M. Davey Smith G. Schneider M. Minder C. Bias in meta-analysis detected by a simple, graphical test.BMJ. 1997; 315: 629-634Crossref PubMed Scopus (33691) Google Scholar]. All statistical analyses were conducted with Comprehensive Meta-analysis v2.2 (Biostat Inc, Englewood, NJ) or Stata version 11.0 (Stata Corp, College Station, TX). A total of 209 studies were identified through PubMed database and other sources. After exclusion of duplicate or irrelevant references, 28 studies remained for assessment. The study selection process is presented in Figure 1 according to the PRISMA statement [8Moher D. Liberati A. Tetzlaff J. Altman D.G. PRISMA GroupPreferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.BMJ. 2009; 339: b2535Crossref PubMed Scopus (14642) Google Scholar]. One study was separated into two studies because it reported data on two different bioprostheses [9Moorjani N. Modi A. Mattam K. et al.Aortic root replacement using a biovalsalva prosthesis in comparison to a "handsewn" composite bioprosthesis.J Card Surg. 2010; 25: 321-326Crossref PubMed Scopus (8) Google Scholar]. A total of 29 series were therefore assessed [9Moorjani N. Modi A. Mattam K. et al.Aortic root replacement using a biovalsalva prosthesis in comparison to a "handsewn" composite bioprosthesis.J Card Surg. 2010; 25: 321-326Crossref PubMed Scopus (8) Google Scholar, 10Doty D.B. Cafferty A. Kon N.D. Huysmans H.A. Krause Jr., A.H. Westaby S. Medtronic Freestyle aortic root bioprosthesis: implant techniques.J Card Surg. 1998; 13: 369-375Crossref PubMed Scopus (28) Google Scholar, 11Wendler O. Dzindzibadze V. Langer F. El Dsoki S. Schäfers H.J. Aortic valve replacement with a stentless bioprosthesis using the full-root technique.Thorac Cardiovasc Surg. 2001; 49: 361-364Crossref PubMed Scopus (9) Google Scholar, 12Ehrlich M.P. Ergin M.A. McCullough J.N. et al.Favorable outcome after composite valve-graft replacement in patients older than 65 years.Ann Thorac Surg. 2001; 71: 1454-1459Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar, 13Kon N.D. Riley R.D. Adair S.M. Kitzman D.W. Cordell A.R. Eight-year results of aortic root replacement with the freestyle stentless porcine aortic root bioprosthesis.Ann Thorac Surg. 2002; 73: 1817-1821Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar, 14Müller L.C. Chevtchik O. Bonatti J.O. Müller S. Fille M. Laufer G. Treatment of destructive aortic valve endocarditis with the Freestyle Aortic Root Bioprosthesis.Ann Thorac Surg. 2003; 75: 453-456Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar, 15Carrel T.P. Berdat P. Englberger L. et al.Aortic root replacement with a new stentless aortic valve xenograft conduit: preliminary hemodynamic and clinical results.J Heart Valve Dis. 2003; 12: 752-757PubMed Google Scholar, 16Melina G. De Robertis F. Gaer J.A. Amrani M. Khaghani A. Yacoub M.H. Mid-term pattern of survival, hemodynamic performance and rate of complications after medtronic freestyle versus homograft full aortic root replacement: results from a prospective randomized trial.J Heart Valve Dis. 2004; 13: 972-975PubMed Google Scholar, 17Kunihara T. Schmidt K. Glombitza P. Dzindzibadze V. Lausberg H. Schäfers H.J. Root replacement using stentless valves in the small aortic root: a propensity score analysis.Ann Thorac Surg. 2006; 82: 1379-1384Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar, 18Etz C.D. Homann T.M. Rane N. et al.Aortic root reconstruction with a bioprosthetic valved conduit: a consecutive series of 275 procedures.J Thorac Cardiovasc Surg. 2007; 133: 1455-1463Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar, 19Di Bartolomeo R. Botta L. Leone A. et al.Bio-Valsalva prosthesis: 'new' conduit for 'old' patients.Interact Cardiovasc Thorac Surg. 2008; 7: 1062-1066Crossref PubMed Scopus (14) Google Scholar, 20Bochenek-Klimczyk K. Lau K.K. Galiñanes M. Sosnowski A.W. Preassembled stentless valved-conduit for the replacement of the ascending aorta and aortic root.Interact Cardiovasc Thorac Surg. 2008; 7: 964-968Crossref PubMed Scopus (9) Google Scholar, 21Dapunt O.E. Easo J. Hölzl P.P. et al.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: 554-559Crossref PubMed Scopus (39) Google Scholar, 22LeMaire S.A. Green S.Y. Sharma K. et al.Aortic root replacement with stentless porcine xenografts: early and late outcomes in 132 patients.Ann Thorac Surg. 2009; 87: 503-512Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar, 23Tabata M. Takayama H. Bowdish M.E. Smith C.R. Stewart A.S. Modified Bentall operation with bioprosthetic valved conduit: Columbia University experience.Ann Thorac Surg. 2009; 87: 1969-1970Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 24Lehmann S. Walther T. Leontyev S. et al.The Toronto Root bioprosthesis: midterm results in 186 patients.Ann Thorac Surg. 2009; 87: 1751-1756Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 25Urbanski P.P. Heinz N. Zhan X. Hijazi H. Zacher M. Diegeler A. Modified bio-Bentall procedure: 10-year experience.Eur J Cardiothorac Surg. 2010; 37: 1317-1321Crossref PubMed Scopus (21) Google Scholar, 26Stewart A.S. Takayama H. Smith C.R. Modified Bentall operation with a novel biologic valved conduit.Ann Thorac Surg. 2010; 89: 938-941Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, 27Etz C.D. Bischoff M.S. Bodian C. et al.The Bentall procedure: is it the gold standard? A series of 597 consecutive cases.J Thorac Cardiovasc Surg. 2010; 140: S64-S70Abstract Full Text Full Text PDF PubMed Scopus (79) Google Scholar, 28Baraki H. Al Ahmad A. Sarikouch S. et al.The first fifty consecutive Bentall operations with a prefabricated tissue-valved aortic conduit: a single-center experience.J Heart Valve Dis. 2010; 19: 286-291PubMed Google Scholar, 29Desai N.D. McCarthy F. Moser W. et al.Durability of porcine bioroots in younger patients with aortic root pathology: a propensity-matched comparison with composite mechanical roots.Ann Thorac Surg. 2011; 92: 2054-2060Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar, 30Galiñanes 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: 86Crossref PubMed Scopus (15) Google Scholar, 31Kaya A. Heijmen R.H. Kelder J.C. Schepens M.A. Morshuis W.J. Stentless biological valved conduit for aortic root replacement: initial experience with the Shelhigh BioConduit model NR-2000C.J Thorac Cardiovasc Surg. 2011; 141: 1157-1162Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar, 32Ennker I.C. Albert A. Dalladaku F. Rosendahl U. Ennker J. Florath I. Midterm outcome after aortic root replacement with stentless porcine bioprostheses.Eur J Cardiothorac Surg. 2011; 40: 429-434PubMed Google Scholar, 33Mazzola A. Di Mauro M. Pellone F. et al.Freestyle aortic root bioprosthesis is a suitable alternative for aortic root replacement in elderly patients: a propensity score study.Ann Thorac Surg. 2012; 94: 1185-1190Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 34Kaya A. Heijmen R.H. Kelder J.C. Morshuis W.J. First 102 patients with the BioValsalva conduit for aortic root replacement.Ann Thorac Surg. 2012; 94: 72-77Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar, 35Gatti G. Dell'Angela L. Pinamonti B. et al.Aortic root replacement with a stented bioprosthetic valved conduit: mid-term results.J Heart Valve Dis. 2013; 22: 500-508PubMed Google Scholar, 36Smith C.R. Stamou S.C. Hooker R.L. et al.Stentless root bioprosthesis for repair of acute type A aortic dissection.J Thorac Cardiovasc Surg. 2013; 145: 1540-1544Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar]. All of the included studies were retrospective observational studies except one prospective series [16Melina G. De Robertis F. Gaer J.A. Amrani M. Khaghani A. Yacoub M.H. Mid-term pattern of survival, hemodynamic performance and rate of complications after medtronic freestyle versus homograft full aortic root replacement: results from a prospective randomized trial.J Heart Valve Dis. 2004; 13: 972-975PubMed Google Scholar]. Fourteen studies had more than 100 patients (range, 101 to 317 patients) [10Doty D.B. Cafferty A. Kon N.D. Huysmans H.A. Krause Jr., A.H. Westaby S. Medtronic Freestyle aortic root bioprosthesis: implant techniques.J Card Surg. 1998; 13: 369-375Crossref PubMed Scopus (28) Google Scholar, 11Wendler O. Dzindzibadze V. Langer F. El Dsoki S. Schäfers H.J. Aortic valve replacement with a stentless bioprosthesis using the full-root technique.Thorac Cardiovasc Surg. 2001; 49: 361-364Crossref PubMed Scopus (9) Google Scholar, 13Kon N.D. Riley R.D. Adair S.M. Kitzman D.W. Cordell A.R. Eight-year results of aortic root replacement with the freestyle stentless porcine aortic root bioprosthesis.Ann Thorac Surg. 2002; 73: 1817-1821Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar, 18Etz C.D. Homann T.M. Rane N. et al.Aortic root reconstruction with a bioprosthetic valved conduit: a consecutive series of 275 procedures.J Thorac Cardiovasc Surg. 2007; 133: 1455-1463Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar, 21Dapunt O.E. Easo J. Hölzl P.P. et al.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: 554-559Crossref PubMed Scopus (39) Google Scholar, 22LeMaire S.A. Green S.Y. Sharma K. et al.Aortic root replacement with stentless porcine xenografts: early and late outcomes in 132 patients.Ann Thorac Surg. 2009; 87: 503-512Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar, 24Lehmann S. Walther T. Leontyev S. et al.The Toronto Root bioprosthesis: midterm results in 186 patients.Ann Thorac Surg. 2009; 87: 1751-1756Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 25Urbanski P.P. Heinz N. Zhan X. Hijazi H. Zacher M. Diegeler A. Modified bio-Bentall procedure: 10-year experience.Eur J Cardiothorac Surg. 2010; 37: 1317-1321Crossref PubMed Scopus (21) Google Scholar, 27Etz C.D. Bischoff M.S. Bodian C. et al.The Bentall procedure: is it the gold standard? A series of 597 consecutive cases.J Thorac Cardiovasc Surg. 2010; 140: S64-S70Abstract Full Text Full Text PDF PubMed Scopus (79) Google Scholar, 29Desai N.D. McCarthy F. Moser W. et al.Durability of porcine bioroots in younger patients with aortic root pathology: a propensity-matched comparison with composite mechanical roots.Ann Thorac Surg. 2011; 92: 2054-2060Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar, 31Kaya A. Heijmen R.H. Kelder J.C. Schepens M.A. Morshuis W.J. Stentless biological valved conduit for aortic root replacement: initial experience with the Shelhigh BioConduit model NR-2000C.J Thorac Cardiovasc Surg. 2011; 141: 1157-1162Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar, 32Ennker I.C. Albert A. Dalladaku F. Rosendahl U. Ennker J. Florath I. Midterm outcome after aortic root replacement with stentless porcine bioprostheses.Eur J Cardiothorac Surg. 2011; 40: 429-434PubMed Google Scholar, 34Kaya A. Heijmen R.H. Kelder J.C. Morshuis W.J. First 102 patients with the BioValsalva conduit for aortic root replacement.Ann Thorac Surg. 2012; 94: 72-77Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar, 35Gatti G. Dell'Angela L. Pinamonti B. et al.Aortic root replacement with a stented bioprosthetic valved conduit: mid-term results.J Heart Valve Dis. 2013; 22: 500-508PubMed Google Scholar], including two multicenter registries [10Doty D.B. Cafferty A. Kon N.D. Huysmans H.A. Krause Jr., A.H. Westaby S. Medtronic Freestyle aortic root bioprosthesis: implant techniques.J Card Surg. 1998; 13: 369-375Crossref PubMed Scopus (28) Google Scholar, 32Ennker I.C. Albert A. Dalladaku F. Rosendahl U. Ennker J. Florath I. Midterm outcome after aortic root replacement with stentless porcine bioprostheses.Eur J Cardiothorac Surg. 2011; 40: 429-434PubMed Google Scholar], and the remaining series had fewer than 100 patients (range, 10 to 80 patients) [9Moorjani N. Modi A. Mattam K. et al.Aortic root replacement using a biovalsalva prosthesis in comparison to a "handsewn" composite bioprosthesis.J Card Surg. 2010; 25: 321-326Crossref PubMed Scopus (8) Google Scholar, 12Ehrlich M.P. Ergin M.A. McCullough J.N. et al.Favorable outcome after composite valve-graft replacement in patients older than 65 years.Ann Thorac Surg. 2001; 71: 1454-1459Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar, 14Müller L.C. Chevtchik O. Bonatti J.O. Müller S. Fille M. Laufer G. Treatment of destructive aortic valve endocarditis with the Freestyle Aortic Root Bioprosthesis.Ann Thorac Surg. 2003; 75: 453-456Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar, 15Carrel T.P. Berdat P. Englberger L. et al.Aortic root replacement with a new stentless aortic valve xenograft conduit: preliminary hemodynamic and clinical results.J Heart Valve Dis. 2003; 12: 752-757PubMed Google Scholar, 16Melina G. De Robertis F. Gaer J.A. Amrani M. Khaghani A. Yacoub M.H. Mid-term pattern of survival, hemodynamic performance and rate of complications after medtronic freestyle versus homograft full aortic root replacement: results from a prospective randomized trial.J Heart Valve Dis. 2004; 13: 972-975PubMed Google Scholar, 17Kunihara T. Schmidt K. Glombitza P. Dzindzibadze V. Lausberg H. Schäfers H.J. Root replacement using stentless valves in the small aortic root: a propensity score analysis.Ann Thorac Surg. 2006; 82: 1379-1384Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar, 19Di Bartolomeo R. Botta L. Leone A. et al.Bio-Valsalva prosthesis: 'new' conduit for 'old' patients.Interact Cardiovasc Thorac Surg. 2008; 7: 1062-1066Crossref PubMed Scopus (14) Google Scholar, 20Bochenek-Klimczyk K. Lau K.K. Galiñanes M. Sosnowski A.W. Preassembled stentless valved-conduit for the replacement of the ascending aorta and aortic root.Interact Cardiovasc Thorac Surg. 2008; 7: 964-968Crossref PubMed Scopus (9) Google Scholar, 23Tabata M. Takayama H. Bowdish M.E. Smith C.R. Stewart A.S. Modified Bentall operation with bioprosthetic valved conduit: Columbia University experience.Ann Thorac Surg. 2009; 87: 1969-1970Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 26Stewart A.S. Takayama H. Smith C.R. Modified Bentall operation with a novel biologic valved conduit.Ann Thorac Surg. 2010; 89: 938-941Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, 28Baraki H. Al Ahmad A. Sarikouch S. et al.The first fifty consecutive Bentall operations with a prefabricated tissue-valved aortic conduit: a single-center experience.J Heart Valve Dis. 2010; 19: 286-291PubMed Google Scholar, 30Galiñanes 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: 86Crossref PubMed Scopus (15) Google Scholar, 33Mazzola A. Di Mauro M. Pellone F. et al.Freestyle aortic root bioprosthesis is a suitable alternative for aortic root replacement in elderly patients: a propensity score study.Ann Thorac Surg. 2012; 94: 1185-1190Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 36Smith C.R. Stamou S.C. Hooker R.L. et al.Stentless root bioprosthesis for repair of acute type A aortic dissection.J Thorac Cardiovasc Surg. 2013; 145: 1540-1544Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar]. Fourteen studies reported follow-up greater than 36 months (range, 37 to 92 months) [10Doty D.B. Cafferty A. Kon N.D. Huysmans H.A. Krause Jr., A.H. Westaby S. Medtronic Freestyle aortic root bioprosthesis: implant techniques.J Card Surg. 1998; 13: 369-375Crossref PubMed Scopus (28) Google Scholar, 12Ehrlich M.P. Ergin M.A. McCullough J.N. et al.Favorable outcome after composite valve-graft replacement in patients older than 65 years.Ann Thorac Surg. 2001; 71: 1454-1459Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar, 16Melina G. De Robertis F. Gaer J.A. Amrani M. Khaghani A. Yacoub M.H. Mid-term pattern of survival, hemodynamic performance and rate of complications after medtronic freestyle versus homograft full aortic root replacement: results from a prospective randomized trial.J Heart Valve Dis. 2004; 13: 972-975PubMed Google Scholar, 18Etz C.D. Homann T.M. Rane N. et al.Aortic root reconstruction with a bioprosthetic valved conduit: a consecutive series of 275 procedures.J Thorac Cardiovasc Surg. 2007; 133: 1455-1463Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar, 21Dapunt O.E. Easo J. Hölzl P.P. et al.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: 554-559Crossref PubMed Scopus (39) Google Scholar, 22LeMaire S.A. Green S.Y. Sharma K. et al.Aortic root replacement with stentless porcine xenografts: early and late outcomes in 132 patients.Ann Thorac Surg. 2009; 87: 503-512Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar, 24Lehmann S. Walther T. Leontyev S. et al.The Toronto Root bioprosthesis: midterm results in 186 patients.Ann Thorac Surg. 2009; 87: 1751-1756Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 25Urbanski P.P. Heinz N. Zhan X. Hijazi H. Zacher M. Diegeler A. Modified bio-Bentall procedure: 10-year experience.Eur J Cardiothorac Surg. 2010; 37: 1317-1321Crossref PubMed Scopus (21) Google Scholar, 27Etz C.D. Bischoff M.S. Bodian C. et al.The Bentall procedure: is it the gold standard? A series of 597 consecutive cases.J Thorac Cardiovasc Surg. 2010; 140: S64-S70Abstract Full Text Full Text PDF PubMed Scopus (79) Google Scholar, 30Galiñanes 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: 86Crossref PubMed Scopus (15) Google Scholar, 31Kaya A. Heijmen R.H. Kelder J.C. Schepens M.A. Morshuis W.J. Stentless biological valved conduit for aortic root replacement: initial experience with the Shelhigh BioConduit model NR-2000C.J Thorac Cardiovasc Surg. 2011; 141: 1157-1162Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar, 33Mazzola A. Di Mauro M. Pellone F. et al.Freestyle aortic root bioprosthesis is a suitable alternative for aortic root replacement in elderly patients: a propensity score study.Ann Thorac Surg. 2012; 94: 1185-1190Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar, 34Kaya A. Heijmen R.H. Kelder J.C. Morshuis W.J. First 102 patients with the BioValsalva conduit for aortic root replacement.Ann Thorac Surg. 2012; 94: 72-77Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar, 35Gatti G. Dell'Angela L. Pinamonti B. et al.Aortic root replacement with a stented bioprosthetic valved conduit: mid-term results.J Heart Valve Dis. 2013; 22: 500-508PubMed Google Scholar]. Five studies had follow-up less than 3 years (range, 6 to 24 months) [14Müller L.C. Chevtchik O. Bonatti J.O. Müller S. Fille M. Laufer G. Treatment of destructive aortic valve endocarditis with the Freestyle Aortic Root Bioprosthesis.Ann Thorac Surg. 2003; 75: 453-456Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar, 20Bochenek-Klimczyk K. Lau K.K. Galiñanes M. Sosnowski A.W. Preassembled stentless valved-conduit for the replacement of the ascending aorta and aortic root.Interact Cardiovasc Thorac Surg. 2008; 7: 964-968Crossref PubMed Scopus (9) Google Scholar, 23Tabata M. Takayama H. Bowdish M.E. Smith C.R. Stewart A.S. Modified Bentall operation with bioprosthetic valved conduit: Columbia University experience.Ann Thorac Surg. 2009; 87: 1969-1970Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 28Baraki H. Al Ahmad A. Sarikouch S. et al.The first fifty consecutive Bentall operations with a prefabricated tissue-valved aortic conduit: a single-center experience.J Heart Valve Dis. 2010; 19: 286-291PubMed Google Scholar, 36Smith C.R. Stamou S.C. Hooker R.L. et al.Stentless root bioprosthesis for repair of acute type A aortic dissection.J Thorac Cardiovasc Surg. 2013; 145: 1540-1544Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar], and the remaining studies did not report length of follow-up [9Moorjani N. Modi A. Mattam K. et al.Aortic root replacement using a biovalsalva prosthesis in comparison to a "handsewn" composite bioprosthesis.J Card Surg. 2010; 25: 321-326Crossref PubMed Scopus (8) Google Scholar, 11Wendler O. Dzindzibadze V. Langer F. El Dsoki S. Schäfers H.J. Aortic valve replacement with a stentless bioprosthesis using the full-root technique.Thorac Cardiovasc Surg. 2001; 49: 361-364Crossref PubMed Scopus (9) Google Scholar, 13Kon N.D. Riley R.D. Adair S.M. Kitzman D.W. Cordell A.R. Eight-year results of aortic root replacement with the freestyle stentless porcine aortic root bioprosthesis.Ann Thorac Surg. 2002; 73: 1817-1821Abstract Full Text Full Text PDF PubMed Scopus (64) Google Scholar, 17Kunihara T. Schmidt K. Glombitza P. Dzindzibadze V. Lausberg H. Schäfers H.J. Root replacement using stentless valves in the small aortic root: a propensity score analysis.Ann Thorac Surg. 2006; 82: 1379-1384Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar, 19Di Bartolomeo R. Botta L. Leone A. et al.Bio-Valsalva prosthesis: 'new' conduit for 'old' patients.Interact Cardiovasc Thorac Surg. 2008; 7: 1062-1066Crossref PubMed Scopus (14) Google Scholar, 26Stewart A.S. Takayama H. Smith C.R. Modified Bentall operation with a novel biologic valved conduit.Ann Thorac Surg. 2010; 89: 938-941Abstract Full Text Full Text PDF PubMed Scopus (23) Google Scholar, 29Desai N.D. McCarthy F. Moser W. et al.Durability of porcine bioroots in younger patients with aortic root pathology: a propensity-matched comparison with composite mechanical roots.Ann Thorac Surg. 2011; 92: 2054-2060Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar, 32Ennker I.C. Albert A. Dalladaku F. Rosendahl U. Ennker J. Florath I. Midterm outcome after aortic root replacement with stentless porcine bioprostheses.Eur J Cardiothorac Surg. 2011; 40: 429-434PubMed Google Scholar]. The study characteristics are summarized in Table 1. In these 29 series, 3,298 patients underwent the Bental
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