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Aortic root replacement with coronary button re-implantation: low risk and predictable outcome
S Westaby1, T Katsumata, G Vaccari
1Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford, UK. swestaby@AHF.org.uk
Summary
Aortic root replacement surgery demonstrated predictable outcomes with button reimplantation, eliminating coronary aneurysms and showing 79% survival at 5 years. This method is safe and effective for cardiac surgery patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Anesthesia
Background:
- Cardiac morbidity in aortic root replacement is often linked to myocardial ischemia.
- Understanding coronary complications and mortality risk factors is crucial for improving surgical outcomes.
Purpose of the Study:
- To analyze a decade of aortic root replacement surgeries performed by a single surgeon.
- To determine the incidence of coronary complications.
- To identify risk factors associated with early mortality in these procedures.
Main Methods:
- A retrospective analysis of 140 aortic root replacement patients (1988-1999).
- Included patients with Marfan's syndrome, root infection, and reoperations.
- Detailed surgical techniques including coronary ostia reimplantation were recorded.
Main Results:
- Hospital mortality was 5.7% (8 deaths).
- Risk factors for mortality included NYHA class IV, shock, low LVEF, acute dissection, and prolonged pump time.
- No late coronary false aneurysms were observed, and myocardial ischemia did not contribute to mortality.
Conclusions:
- Button reimplantation of coronary ostia is a safe and predictable technique.
- The described surgical sequence is effective, rendering wrap-around techniques unnecessary.
- This approach has successfully eliminated late coronary aneurysms.