{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:56:50Z","timestamp":1760147810542,"version":"build-2065373602"},"reference-count":17,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,3,2]],"date-time":"2023-03-02T00:00:00Z","timestamp":1677715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Objective: Outcomes after surgical aortic root replacement using different valved conduits are rarely reported. The present study shows the experience of a single center with the use of the partially biological LABCOR (LC) conduit and the fully biological BioIntegral (BI) conduit. Special attention was paid to preoperative endocarditis. Methods: All 266 patients who underwent aortic root replacement by an LC conduit (n = 193) or a BI conduit (n = 73) between 01\/01\/2014 and 31\/12\/2020 were studied retrospectively. Dependency on an extracorporeal life support system preoperatively and congenital heart disease were exclusion criteria. For patients with (n = 67) and without (n = 199) preoperative endocarditis subanalyses were made. Results: Patients treated with a BI conduit were more likely to have diabetes mellitus (21.9 vs. 6.7%, p &lt; 0.001), previous cardiac surgery (86.3 vs. 16.6%; p &lt; 0.001), permanent pacemaker (21.9 vs. 2.1%; p &lt; 0.001), and had a higher EuroSCORE II (14.9 vs. 4.1%; p &lt; 0.001). The BI conduit was used more frequently for prosthetic endocarditis (75.3 vs. 3.6%; &lt;0.001), and the LC conduit was used predominantly for ascending aortic aneurysms (80.3 vs. 41.1%; &lt;0.001) and Stanford type A aortic dissections (24.9 vs. 9.6%; p = 0.006). The LC conduit was used more often for elective (61.7 vs. 47.9%; p = 0.043) and emergency (27.5 vs. 15.1%; p = 0\u2013035) surgeries, and the BI conduit for urgent surgeries (37.0 vs. 10.9%; p &lt; 0.001). Conduit sizes did not differ significantly, with a median of 25 mm in each case. Surgical times were longer in the BI group. In the LC group, coronary artery bypass grafting and proximal or total replacement of the aortic arch were combined more frequently, whereas in the BI group, partial replacement of the aortic arch were combined. In the BI group, ICU length of stay and duration of ventilation were longer, and rates of tracheostomy and atrioventricular block, pacemaker dependence, dialysis, and 30-day mortality were higher. Atrial fibrillation occurred more frequently in the LC group. Follow-up time was longer and rates of stroke and cardiac death were less frequent in the LC group. Postoperative echocardiographic findings at follow-up were not significantly different between conduits. Survival of LC patients was better than that of BI patients. In the subanalysis of patients with preoperative endocarditis, significant differences between the used conduits were found with respect to previous cardiac surgery, EuroSCORE II, aortic valve and prosthesis endocarditis, elective operation, duration of operation, and proximal aortic arch replacement. For patients without preoperative endocarditis, significant differences were observed concerning previous cardiac surgery, pacemaker implantation history, duration of procedure, and bypass time. The Kaplan\u2013Meier curves for the subanalyses showed no significant differences between the used conduits. Conclusions: Both biological conduits studied here are equally suitable in principle for complete replacement of the aortic root in all aortic root pathologies. The BI conduit is often used in bail-out situations, especially in severe endocarditis, without being able to show a clinical advantage over the LC conduit in this context.<\/jats:p>","DOI":"10.3390\/jcdd10030107","type":"journal-article","created":{"date-parts":[[2023,3,2]],"date-time":"2023-03-02T02:10:59Z","timestamp":1677723059000},"page":"107","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Aortic Root Replacement Surgery\u2014A Center Experience with Biological Valve Prostheses"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0106-8205","authenticated-orcid":false,"given":"Mohamed","family":"Salem","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"},{"name":"Department of Pediatric Cardiac Surgery, Pediatric Cardiac Centre, University Hospital of Gie\u00dfen and Marburg, Campus Gie\u00dfen, 35385 Gie\u00dfen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maximilian","family":"Boehme","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4228-7164","authenticated-orcid":false,"given":"Christine","family":"Friedrich","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Ernst","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4990-1892","authenticated-orcid":false,"given":"Thomas","family":"Puehler","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg\/Kiel\/L\u00fcbeck, Potsdamer Str. 58, 10785 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9145-3210","authenticated-orcid":false,"given":"Georg","family":"Lutter","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"},{"name":"DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg\/Kiel\/L\u00fcbeck, Potsdamer Str. 58, 10785 Berlin, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix","family":"Schoeneich","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Assad","family":"Haneya","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jochen","family":"Cremer","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Schoettler","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1097\/00019501-200204000-00002","article-title":"Ascending aortic aneurysm and aortic root disease","volume":"13","author":"Yun","year":"2002","journal-title":"Coron. Artery Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1016\/S0003-4975(00)01716-1","article-title":"Reconstruction of the ascending aorta and aortic root: Experience in 45 consecutive patients","volume":"70","author":"Underwood","year":"2000","journal-title":"Ann. Thorac. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1136\/thx.23.4.338","article-title":"A technique for complete replacement of the ascending aorta","volume":"23","author":"Bentall","year":"1968","journal-title":"Thorax"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/S0022-5223(19)34942-6","article-title":"An aortic valve-sparing operation for patients with aortic incompetence and aneurysm oft he ascending aorta","volume":"103","author":"David","year":"1992","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/S0022-5223(19)34225-4","article-title":"Remodeling of the aortic valve anulus","volume":"105","author":"Sarsam","year":"1993","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1016\/j.athoracsur.2005.07.023","article-title":"Early postoperative anticoagulation after mechanical valve replacement: A systematic review","volume":"81","author":"Kulik","year":"2006","journal-title":"Ann. Thorac. Surg."},{"key":"ref_7","first-page":"440","article-title":"Root replacement for graft infection using an all-biologic xenopericardial conduit","volume":"25","author":"Guenther","year":"2016","journal-title":"J. Heart Valve Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1016\/j.jtcvs.2015.07.015","article-title":"Contemporary outcomes of surgery for aortic root aneurysm: A propensity-matched comparison of valve-sparing and composite valve graft replacement","volume":"150","author":"Gaudino","year":"2015","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Caceres, M., Ma, Y., Rankin, J.S., Saha-Chaudhuri, P., Gammie, J.S., Suri, R.M., Thourani, V.H., Englum, B.R., Esmailian, F., and Czer, L.S. (2014). Evolving practice trends of aortic root surgery in North America. Ann. Thorac. Surg.","DOI":"10.1016\/j.athoracsur.2014.07.053"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1016\/j.athoracsur.2015.10.043","article-title":"Transatrial cannulation of the left ventricle for acute type A aortic dissection: A 5-year experience","volume":"101","author":"Grothusen","year":"2016","journal-title":"Ann. Thorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1055\/s-0039-1683425","article-title":"Outcomes of Patients after Implantation oft he Pericardial All-Biological Valve No-React Aortic Conduit (BioIntegral) for Root Replacement in Complex Surgical Procedures","volume":"68","author":"Puehler","year":"2020","journal-title":"Thorac. Cardiovasc. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/j.ejcts.2009.06.021","article-title":"Aortic valve repair leads to a low incidence of valve-related complications","volume":"37","author":"Aicher","year":"2010","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/j.jtcvs.2007.05.052","article-title":"Aortic root remodeling: Ten-year experience with 274 patients","volume":"134","author":"Aicher","year":"2007","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1067\/mtc.2001.112935","article-title":"Results of aortic valve-sparing operations","volume":"122","author":"David","year":"2001","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1016\/j.jtcvs.2014.06.025","article-title":"Homograft use in reoperative aortic root and proximal aortic surgery for endocarditis: A 12-year experience in high-risk patients","volume":"148","author":"Preventza","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1093\/icvts\/ivw066","article-title":"Comparison of mid-term haemodynamic performance between the BioValsalva and the BioIntegral valved conduits after aortic root replacement","volume":"23","author":"Wendt","year":"2016","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1016\/j.jtcvs.2013.05.014","article-title":"Freestyle root replacement for complex destructive aortic valve endocarditis","volume":"147","author":"Heinz","year":"2014","journal-title":"J. Thorac. Cardiovasc. 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