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

@entity1 @entity64 @entity712 @entity296 @entity548 @entity67 @entity5 @entity881 @entity1576 @entity1167 @entity715 @entity472 @entity204
BACKGROUND AND AIM OF THE STUDY: Aortic valve replacement (AVR) in @entity1 with a heavily calcified ascending aorta and aortic root, or with conditions 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 @entity1 with acquired @entity472 is reported. METHODS: Between 1995 and 2003, 13 @entity1 (mean age 71 years) underwent AAC for severe @entity472 (mean valve area 0.65 +/- 0.02 cm2). Indications for AAC were heavily calcified ascending aorta and aortic root (n = 5), patent retrosternal mammary grafts (n = 4), calcified ascending aorta and aortic root plus patent retrosternal mammary graft (n = 1), retrosternal colonic interposition (n = 1) and multiple previous sternotomies (n = 2). Seven @entity1 had previous coronary artery bypass grafting (CABG). The mean preoperative left ventricular ejection fraction was 50 +/- 4%. RESULTS: AAC were performed under cardiopulmonary 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). @entity1167 was used in one @entity1 . 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 @entity1 underwent simultaneous CABG. Three @entity1 died in-hospital from @entity67 (n = 1), intravascular @entity715 (n = 1) and @entity881 (n = 1). The mean hospital stay was 26 days. Complications included @entity1576 requiring tracheostomy (n = 2), @entity64 (n = 1) and re-exploration for @entity548 (n = 2). At a mean follow up of 2.1 years, there have been four late deaths; causes of @entity204 were @entity712 (n = 2), @entity296 (n = 1) and @entity5 (n = 1). CONCLUSION: AAC provides an acceptable alternative to AVR in selected @entity1 who are at exceedingly high risk for the standard procedure.
