**8. Aortic root replacement with cryopreserved homograft**

Aortic root replacement with cryopreserved homograft tissue is often used for patients with an infected aortic root [44]. The structure of the homograft that includes the muscular part of the left ventricular outflow tract, the anterior mitral leaflet and the aorto-mitral continuity; these provide additional tissue to fill gaps created by aggressive debridement while treating endocarditis [44, 45]. Homograft provide excellent hemodynamics and do not need anti-coagulation. Reports demonstrate improved left ventricular mass regression and ejection fraction after homograft root replacement [46]. However, we would caution their use in young patients. Valve degeneration and subsequent need for re-operation is often inversely proportional to age at implant [44] (**Figure 3**).

We feel that appropriate debridement rather than prosthesis selection determines outcome in patients with aortic root abscess. Jassar et al. reported similar rates of reinfection and reoperation in 134 patients who had aortic root replacement using either cryopreserved homograft, biological or mechanical valved conduits [47].

**41**

**Figure 4.**

*Aortic Root Reconstruction*

period [52] (**Figure 4**).

valved-conduit or bioprosthesis):

in end-to-side manner to the vessel is used.

*DOI: http://dx.doi.org/10.5772/intechopen.86034*

**9. Aortic root replacement using stentless xenograft**

Stent-less valve conduit (Freestyle™ valve conduit, Medtronic Corporation, Minnesota, USA) are commercially easily available when compared to homograft tissue. Thus, in recent years, they are the prosthesis of choice for aortic root replacement in the elderly or those with an infective etiology [49]. Hemodynamics match those of homograft, especially in patients with a small aortic root [50]. The sinus structure of these valves mirrors the native aortic root; an additional benefit when compared to a stented valve conduit [49]. However, unlike stented bio-prostheses, the mechanism of failure of these valves is often leaflet tears [51]. These can occur suddenly leading to acute aortic regurgitation and left heart failure. LeMaire and colleagues demonstrated in 132 patients who had porcine bioroot replacement that there was no structural valve dysfunction in any case during the 5 year follow up

Here are the relevant steps that we use for our root replacement procedures. These steps remain the same irrespective of the type of prosthesis (mechanical

1.We routinely cannulate the right axillary artery for arterial access in cardiopulmonary bypass in all patients with ascending aortic involvement with aneurysmal disease and certainly in all patients with aortic dissection. Our preferred method is direct cannulation of the axillary artery with a straight cannula (usually 18 or 20Fr); otherwise, an 8 mm vascular graft anastomosed

*The free style porcine bioprosthesis with re-implantation of the coronary buttons is demonstrated [53].*

**Figure 3.** *The insertion of cryopreserved aortic homograft is indicated [48].*

*Cardiac Surgery Procedures*

respectively [43].

conduits [47].

demonstrated in a propensity matched cohorts that included patients who underwent aortic root replacement utilizing mechanical valved conduit versus biological valved conduit versus valve sparing procedure that the type of procedure did not influence early or late outcome, however rate of aortic re-operation was 0, 2.4, 7.3% at 5 years for mechanical, biological valved conduits and valve sparing procedure,

Aortic root replacement with cryopreserved homograft tissue is often used for patients with an infected aortic root [44]. The structure of the homograft that includes the muscular part of the left ventricular outflow tract, the anterior mitral leaflet and the aorto-mitral continuity; these provide additional tissue to fill gaps created by aggressive debridement while treating endocarditis [44, 45]. Homograft provide excellent hemodynamics and do not need anti-coagulation. Reports demonstrate improved left ventricular mass regression and ejection fraction after homograft root replacement [46]. However, we would caution their use in young patients. Valve degeneration and subsequent need for re-operation is often inversely

We feel that appropriate debridement rather than prosthesis selection determines outcome in patients with aortic root abscess. Jassar et al. reported similar rates of reinfection and reoperation in 134 patients who had aortic root replacement using either cryopreserved homograft, biological or mechanical valved

**8. Aortic root replacement with cryopreserved homograft**

proportional to age at implant [44] (**Figure 3**).

*The insertion of cryopreserved aortic homograft is indicated [48].*

**40**

**Figure 3.**
