Is there a role for the left ventricle apical-aortic conduit for acquired aortic stenosis?

Juan A. Crestanello, Kenton J. Zehr, Richard C. Daly, Thomas A. Orszulak, Hartzell V Schaff

Research output: Contribution to journalArticle

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Abstract

Background and aim of the study: Aortic valve replacement (AVR) in patients with a heavily calci-fied ascending aorta and aortic root, or with condi-tions that preclude a median sternotomy, poses a formidable challenge. A left ventricle apical-aortic conduit (AAC) is an alternative in these situations. Herein, the authors' experience with AAC in adult patients with acquired aortic stenosis is reported. Methods: Between 1995 and 2003, 13 patients (mean age 71 years) underwent AAC for severe sympto-matic aortic stenosis (mean valve area 0.65 ± 0.02 cm2). Indications for AAC were heavily calcified ascending aorta and aortic root (n = 5), patent ret-rosternal mammary grafts (n = 4), calcified ascending aorta and aortic root plus patent retrosternal mam-mary graft (n = 1), retrosternal colonic interposition (n = 1) and multiple previous sternotomies (n = 2). Seven patients had previous coronary artery bypass grafting (CABG). The mean preoperative left ventric-ular ejection fraction was 50 ± 4%. Results: AAC were performed under cardiopul-monary bypass through a left thoracotomy (n = 10), median sternotomy (n = 2) or bilateral thoracotomy (n = 1). Hearts were kept beating (n = 5) or fibrillated (n = 7). Circulatory arrest was used in one patient. Composite Dacron conduits with biological (n = 6), mechanical (n = 4) or homograft (n = 2) valves were used. Distal anastomoses were performed in the descending thoracic aorta (n = 12) or in the left iliac artery (n = 1). Two patients underwent simultaneous CABG. Three patients died in-hospital from ventric-ular failure (n = 1), intravascular thrombosis (n = 1) and multi-organ failure (n = 1). The mean hospital stay was 26 days. Complications included respiratory failure requiring tracheostomy (n = 2), stroke (n = 1) and re-exploration for bleeding (n = 2). At a mean fo1-low up of 2.1 years, there have been four late deaths; causes of death were congestive heart failure (n = 2), ischemic cardiomyopathy (n = 1) and cancer (n = 1). Conclusion: AAC provides an acceptable alternative to AVR in selected patients who are at exceedingly high risk for the standard procedure.

Original languageEnglish (US)
Pages (from-to)57-63
Number of pages7
JournalJournal of Heart Valve Disease
Volume13
Issue number1
StatePublished - Jan 2004

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Aortic Valve Stenosis
Heart Ventricles
Sternotomy
Aorta
Thoracotomy
Thoracic Aorta
Aortic Valve
Coronary Artery Bypass
Transplants
Polyethylene Terephthalates
Iliac Artery
Tracheostomy
Cardiomyopathies
Respiratory Insufficiency
Allografts
Cause of Death
Length of Stay
Breast
Thrombosis
Heart Failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Is there a role for the left ventricle apical-aortic conduit for acquired aortic stenosis? / Crestanello, Juan A.; Zehr, Kenton J.; Daly, Richard C.; Orszulak, Thomas A.; Schaff, Hartzell V.

In: Journal of Heart Valve Disease, Vol. 13, No. 1, 01.2004, p. 57-63.

Research output: Contribution to journalArticle

Crestanello, Juan A. ; Zehr, Kenton J. ; Daly, Richard C. ; Orszulak, Thomas A. ; Schaff, Hartzell V. / Is there a role for the left ventricle apical-aortic conduit for acquired aortic stenosis?. In: Journal of Heart Valve Disease. 2004 ; Vol. 13, No. 1. pp. 57-63.
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abstract = "Background and aim of the study: Aortic valve replacement (AVR) in patients with a heavily calci-fied ascending aorta and aortic root, or with condi-tions that preclude a median sternotomy, poses a formidable challenge. A left ventricle apical-aortic conduit (AAC) is an alternative in these situations. Herein, the authors' experience with AAC in adult patients with acquired aortic stenosis is reported. Methods: Between 1995 and 2003, 13 patients (mean age 71 years) underwent AAC for severe sympto-matic aortic stenosis (mean valve area 0.65 ± 0.02 cm2). Indications for AAC were heavily calcified ascending aorta and aortic root (n = 5), patent ret-rosternal mammary grafts (n = 4), calcified ascending aorta and aortic root plus patent retrosternal mam-mary graft (n = 1), retrosternal colonic interposition (n = 1) and multiple previous sternotomies (n = 2). Seven patients had previous coronary artery bypass grafting (CABG). The mean preoperative left ventric-ular ejection fraction was 50 ± 4{\%}. Results: AAC were performed under cardiopul-monary bypass through a left thoracotomy (n = 10), median sternotomy (n = 2) or bilateral thoracotomy (n = 1). Hearts were kept beating (n = 5) or fibrillated (n = 7). Circulatory arrest was used in one patient. Composite Dacron conduits with biological (n = 6), mechanical (n = 4) or homograft (n = 2) valves were used. Distal anastomoses were performed in the descending thoracic aorta (n = 12) or in the left iliac artery (n = 1). Two patients underwent simultaneous CABG. Three patients died in-hospital from ventric-ular failure (n = 1), intravascular thrombosis (n = 1) and multi-organ failure (n = 1). The mean hospital stay was 26 days. Complications included respiratory failure requiring tracheostomy (n = 2), stroke (n = 1) and re-exploration for bleeding (n = 2). At a mean fo1-low up of 2.1 years, there have been four late deaths; causes of death were congestive heart failure (n = 2), ischemic cardiomyopathy (n = 1) and cancer (n = 1). Conclusion: AAC provides an acceptable alternative to AVR in selected patients who are at exceedingly high risk for the standard procedure.",
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AU - Schaff, Hartzell V

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