# The Ticking Clock of Aortic Root Replacement - Single-Center Experience After Urgent and Emergent Aortic Root Replacement Using the BioIntegral and Freestyle™ Bioconduits

## TL;DR

This study examines outcomes of urgent/emergency aortic root replacement surgeries using two bioconduits, finding similar clinical results but higher mortality in reoperative cases.

## Contribution

The paper provides a single-center retrospective analysis of clinical outcomes using BioIntegral and Freestyle™ bioconduits in urgent/emergency aortic root replacement.

## Key findings

- In-hospital and 30-day mortality rates were 15.4% among 26 patients.
- Primary aortic root replacement was associated with significantly higher survival compared to redo cases.
- Clinical outcomes were equal for both BioIntegral and Freestyle™ bioconduits.

## Abstract

Aortic root pathologies needing full aortic root replacement are challenging
entities correlated to high morbidity and mortality due to their complexity
and mostly refer to high-risk patients. In this retrospective study, we
report our surgical experience and clinical results of patients undergoing a
Bentall procedure as primary or reoperative surgery with the application of
aortic bioconduits.

Patients who underwent full aortic root replacement utilizing either
BioIntegral (BI) or Medtronic Freestyle™ (FS) bioconduit in the
Cardiothoracic Surgery Department of the University Hospital Aachen RWTH
from January 2015 until September 2020, in an urgent or emergency setting,
were analyzed and followed up until December 2023.

Twenty-six patients underwent aortic root replacement with bioconduits (N=11
with BI, N=15 with FS) in our center. Twenty-three cases were of infective
cause, and three were of noninfective cause; 30.76% were urgent, and 69.23%
were emergency cases. Two (7.70%) patients died during operation due to
irreversible aortic root damage. In-hospital and 30-day mortality rates were
four out 26 (15.4%) patients. The mean follow-up time for all the patients
was 52.01 ± 39.41 months. Patients who received a primary aortic root
replacement had significantly higher survival than redo cases. BI surgery
needed longer cardiopulmonary bypass times.

Clinical outcome was equal for both bioconduits. Further studies with larger
cohorts are needed for deeper insights into this complex entity.