HEMODYNAMIC PERFORMANCE OF BIOLOGIC

ROOT REPLACEMENTS: PERICARDIAL COMPOSITE V.

PORCINE BIOROOTS

Nimesh Desai MD, Fenton McCarthy, Wilson Szeto MD, Alberto Pochettino

MD, Richard Erwin, Yasmin El-Sayed, Joseph Bavaria MD

Thoracic Aortic Research ProgramUniversity of Pennsylvania School of Medicine

Philadelphia, PA

OBJECTIVES Stentless porcine bioroots were developed as a

root replacement that avoids anticoagulation

Concerns have been raised about porcine bioroots Early structural valve deterioration Increased complexity of reoperation

Renewed interest in pericardial valved composite roots

This study evaluates the hemodynamics of porcine bioroots and pericardial composite roots

Methods Evaluated all patients receiving either a porcine bioroot

(St. Jude Toronto Root) or a pericardial composite root (CE pericardial model 2800 + dacron graft)

Single institution from December 2001-June 2009

All root replacements performed for root pathology

Preoperative, postoperative and greater than one year follow-up echo data was compiled for all patients.

Median follow-up 3.0 years (range 1yr-6.5 yrs)

Patients with endocarditis or acute aortic dissections were excluded

Indications for Root Replacement

Diagnosis

Stentless Porcine Bioroot (n=81)

Pericardial Composite Root (n=95)

AI/Aneurysm

52 49

AS 5 12

Mixed AI/AS 23 16

Other 1* 4**

TOTAL 81 81

*Chronic Dissection**Dehisced AVRs [3], chronic dissection [1]

Results Preop

PREOPEREATIVELY : NO significant differences between the groups

Porcine Bioroots (n=81) Mean +/- SD

Pericardial Composite Roots (n=95) Mean +/-

SDP

value

PREOP

LVEF 58 +/- 13.6 56 +/- 11.5 0.37

AV peak 48 +/- 27.7 50 +/- 27.5 0.4

AV mean

29 +/- 17.2 28 +/-15.8 0.83

LVEDD 6 +/- 0.8 6 +/- 1.1 1

LVESD 4 +/- 0.8 4 +/- 1.2 1

LVMI 135 +/- 32.5 139 +/- 51.4 0.59

Results Postop

POSTOPERATIVELY : NO significant differences between the groups

Porcine Bioroots (n=81) Mean +/- SD

Pericardial Composite Roots (n=95) Mean +/-

SD

P value

POSTOP

LVEF 57 +/- 14.9 60 +/- 16.6 0.23

AV peak 17 +/- 13.8 20 +/- 9.1 0.07

AV mean 9 +/- 8.2 10 +/- 5.0 0.14

LVEDD 5 +/- 0.8 5 +/- 1.0 1

LVESD 3 +/- 0.9 3 +/- 0.8 1

LVMI 131 +/- 42.5 131 +/- 74.4 0.72

Results > 1 Year

Porcine Bioroots (n=81) Mean +/-

SD

Pericardial Composite Roots (n=95) Mean

+/- SD

P value

> 1 YEAR

LVEF 60 +/- 12.2 58 +/- 11.8 0.385

AV peak 13 +/- 7.4 19 +/-7.5 0.0003

AV mean

7 +/- 3.7 10 +/- 3.9 0.0005

LVEDD 5 +/-0.7 5 +/- 1.0 1

LVESD 3 +/-0.9 3 +/- 1.1 1

LVMI 108 +/- 37.4 118 +/- 51 0.25

Valve Size

#19 #21 #23 #25 #27 #290%

10%

20%

30%

40%

50%

60%

70%

Porcine Bioroot Pericardial Composite

Conclusion Porcine bioroots have lower gradients at

greater than one year of follow-up

Gradients were low in both groups overall

Similar left ventricular remodeling as assessed by LV mass regression and LV diameters

Suggests pericardial roots are a viable alternative