Custom-tailored valved conduit for complex aortic root disease.

Abstract

Commercially available conduits containing a valve are not always suitable for simultaneous reconstruction of the left ventricular outflow tract and replacement of the aortic root. We describe our experience with custom-made conduits for patients with complex disease of the aortoventricular junction. Twenty-seven patients with a destroyed aortoventricular junction resulting from endocarditis and/or multiple previous operations had reconstruction of the left ventricular outflow tract with a tailored tubular Dacron graft. The graft was tailored to correct the defect in the outflow tract and sutured with continuous polypropylene sutures directly to the interventricular septum and the intervalvular fibrous body or sewing ring of a prosthetic mitral valve. The coronary arteries were reimplanted as high as anatomically possible and a mechanical (16 patients) or bioprosthetic valve (11 patients) was implanted into the graft below the coronary arteries. Median age of the patients was 55 years. The follow-up was complete, with echocardiographic studies and a median period of 32 months. There were 3 operative and no late deaths. One patient required early reoperation for dehiscence of a patch used to reconstruct the posterior mitral valve annulus. Twenty-four patients were alive at the last follow-up and had a normally functioning aortic valve prosthesis and no false aneurysms. Intraoperatively tailored tubular Dacron graft for concomitant reconstruction of the left ventricular outflow tract and replacement of the aortic root is a useful and safe operative technique for patients with destroyed aortoventricular junction.