COMPLETE REPLACEMENT OF THE ASCENDING AORTA WITH REIMPLANTATION OF THE CORONARY-ARTERIES - NEW SURGICAL APPROACH

  • 1 January 1981
    • journal article
    • research article
    • Vol. 81  (2) , 309-315
Abstract
Patients (30) had total replacement of the ascending aorta with reimplantation of the coronary arteries; 20 for a fusiform aneurysm of the ascending aorta and 10 because of the ascending aorta, of which 3 were acute. All had associated aortic insufficiency. The technique consists of implantation within the aneurysmal sac of a Dacron prosthesis containing a Bjoerk-Shiley aortic valve. The coronary orifices are anastomosed to the tubular Dacron prosthesis by a 2nd smaller Dacron tube. The aneurysmal pouch is closed over the entire appliance and a fistula between the aneurysmal sac and the right atrial appendage is created to drain oozing from the prosthesis. The operative mortality was 10% (3 deaths) and the late mortality was 14.8% (4 deaths). The deaths, early and late, were confined to the first 10 cases, during which time the technique was being developed. There was no mortality among the last 20 patients. The 23 survivors followed for an average of 19 1/2 mo. (range 6 mo.-5 1/2 yr) are in New York Heart Association Functional class I (21) or II (2). The technical modifications utilized in this series simplified the operation and permit the proposal of this technique for aneurysms involving the entire ascending aorta.

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