1. Nimesh Desai MD, Fenton McCarthy, Wilson Szeto MD, Alberto Pochettino MD, Richard Erwin, Yasmin El-Sayed, Joseph Bavaria MD Thoracic Aortic Research Program University of Pennsylvania School of Medicine Philadelphia, PA

2.  Stentless porcine bioroots were developed as a root replacement that avoids anticoagulation  Concerns have been raised about porcine bioroots  Early structural valve deterioration  Increased complexity of reoperation  Renewed interest in pericardial valved composite roots  This study evaluates the hemodynamics of porcine bioroots and pericardial composite roots

3.  Evaluated all patients receiving either a porcine bioroot (St. Jude Toronto Root) or a pericardial composite root (CE pericardial model 2800 + dacron graft)  Single institution from December 2001-June 2009  All root replacements performed for root pathology  Preoperative, postoperative and greater than one year follow-up echo data was compiled for all patients.  Median follow-up 3.0 years (range 1yr-6.5 yrs)  Patients with endocarditis or acute aortic dissections were excluded

4. Diagnosis Stentless Porcine Bioroot (n=81) Pericardial Composite Root (n=95) AI/Aneurys m 5249 AS512 Mixed AI/AS2316 Other1*4** TOTAL81 *Chronic Dissection **Dehisced AVRs [3], chronic dissection [1]

5. PREOPEREATIVELY : NO significant differences between the groups Porcine Bioroots (n=81) Mean +/- SD Pericardial Composite Roots (n=95) Mean +/- SD P value PREOP LVEF 58 +/- 13.656 +/- 11.50.37 AV peak 48 +/- 27.750 +/- 27.50.4 AV mean 29 +/- 17.228 +/-15.80.83 LVEDD 6 +/- 0.86 +/- 1.11 LVESD 4 +/- 0.84 +/- 1.21 LVMI 135 +/- 32.5139 +/- 51.40.59

6. POSTOPERATIVELY : NO significant differences between the groups Porcine Bioroots (n=81) Mean +/- SD Pericardial Composite Roots (n=95) Mean +/- SD P value POSTOP LVEF 57 +/- 14.960 +/- 16.60.23 AV peak 17 +/- 13.820 +/- 9.10.07 AV mean 9 +/- 8.210 +/- 5.00.14 LVEDD 5 +/- 0.85 +/- 1.01 LVESD 3 +/- 0.93 +/- 0.81 LVMI 131 +/- 42.5131 +/- 74.40.72

7. Porcine Bioroots (n=81) Mean +/- SD Pericardial Composite Roots (n=95) Mean +/- SD P value > 1 YEAR LVEF 60 +/- 12.258 +/- 11.80.385 AV peak 13 +/- 7.419 +/-7.50.0003 AV mean 7 +/- 3.710 +/- 3.90.0005 LVEDD 5 +/-0.75 +/- 1.01 LVESD 3 +/-0.93 +/- 1.11 LVMI 108 +/- 37.4118 +/- 510.25

9.  Porcine bioroots have lower gradients at greater than one year of follow-up  Gradients were low in both groups overall  Similar left ventricular remodeling as assessed by LV mass regression and LV diameters  Suggests pericardial roots are a viable alternative