CONCOMITANT RESECTION OF ASCENDING AORTIC-ANEURYSM AND REPLACEMENT OF THE AORTIC-VALVE - OPERATIVE AND LONG-TERM RESULTS WITH CONVENTIONAL TECHNIQUES IN 90 PATIENTS

  • 1 January 1980
    • journal article
    • research article
    • Vol. 79  (3) , 388-401
Abstract
Patients (90) undergoing concomitant resection of ascending aortic aneurysm and aortic valve replacement (AVR) utilizing noncomposite conventional techniques were reviewed to assess the early and late results, to define limitations of this operative approach to clarify the indications for composite reconstruction of the aortic root. Mean age was 55 yr. Twenty percent had Marfan''s syndrome and 13% had aortic dissections. The cause of the aneurysm was dissection in 13% of cases, syphilis in 11%, atherosclerosis in 9% and degeneration (with or without cystic medionecrosis) in 67%. Follow-up averaged 3.8 yr and extended to 11.5 yr maximum. AVR and complete excision of the aneurysm (preserving small tongues of aortic wall circumscribing the coronary artery ostia) coupled with tubular graft replacement of the ascending aorta were performed. Of the patients, 19% required individual technical modifications relating to the coronary arteries. Operative mortality rate was 13%, with the majority of deaths being due to cardiac causes. Contemporary operative mortality rate was 4.3%. Re-exploration for hemorrhage was required and 2.4% had perioperative myocardial infarctions. Late functional results were generally good (average N.Y.H.A. [New York Heart Association] Class 1.4). Late thromboembolism, angina, myocardial infarction and congestive heart failure occurred at linearized rates of 3.4% per patient-year, 4.9% per patient-year 1.1% per patient-year and 5.2% per patient-year, respectively. No prosthetic valve endocarditis, graft infection or recurrent aneurysms of the aortic root were observed. Late reoperation was necessary in 8 patients (3% per patient-year), but reoperation for disease confined to the ascending aorta accounted for only 3 of these cases (1.1% per patient-year). Overall actuarial survival rates were 67% .+-. 5% at 5 yr and 50% .+-. 9% at 10 yr; survival rates for the 78 operative survivors were 77% .+-. 5% and 57% .+-. 10% at the same time intervals, respectively. One late death could be attributed to complications arising in the reconstructed aortic root. Such simple, noncomposite techniques are safe, portend minimal risk of late complications and the attendant necessity for reoperation and provide satisfactory long-term survival. Composite techniques should be primarily reserved for selected cases of advanced necrotizing prosthetic or natural endocarditis.

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