The long-term follow-up of large-diameter Dacron (R) vascular grafts in surgical practice: a review

Synthetic grafts have been widely used in cardiac and vascular surgery since the mid-1970s. Considering the relative lack of randomized clinical trials or systematic analyses in the field of prosthetic large vessel diameter replacement, we reviewed the literature on the long-term performance and surgical management of complications of Dacron (R) grafts in both thoracic and abdominal aorta reconstruction and in the pediatric population. MedLine, Embase and Cochrane Library databases were searched for meta-analyses, reviews, clinical trials, and case reports pertinent to the study object. Aortic replacement with Dacron (R) prostheses is widely performed with acceptable outcome and a relatively low rate of graf-trelated and postimplantation complications, such as rupture, infection and fistulization. However, progressive dilation and mechanical failure of the grafts represent the most worrisome complication in all the districts analyzed. The emerging concept of the mismatch in the biomechanical properties between the prosthetic material and native aorta is thought to be at the root of these complications leading to even more daunting consequences when the ascending aorta is involved. Indeed introduction of a non-compliant prosthesis in place of the native ascending aorta can exert detrimental effects not only at the level of the anastomosis. leading to pseudoanetuysm, but also can influence the optimal performance of the aortic root complex with consequent valve dysfunction and ventricular hypertrophy. Albeit confirming their overall successful performance, this review launches a warning on the current liberal use of non-compliant grafts in aortic position, remarking the need for alternative vascular conduits mimicking the native artery compliance.