[Aortic root replacement of 231 cases]

To discuss the operative indications, methods, and surgical techniques of aortic root replacement for aortic not aneurysm.

Between January 1994 and August 1999, 231 consecutive patients underwent aortic root replacement in our institution, and 13/231 were treated on an emergency basis. They were 189 men and 42 women, ranging in age from 14 to 69 years. The diameter of the aneurysm varied from 4.5 to 11.0 cm. Among this group, 145 had isolated aortic root aneurysms, 65 suffered from DeBakey type I aortic dissection, and the remaining 21 were diagnosed as DeBakey type II aortic dissection. Aortic valve regurgitation was involved in all patients. Aortic root replacement was performed with composite valved graft in 229 patients, and 2 patients reserved the aortic valve.

Hospital mortality was 3.03% (7 patients). The early complications included re-exploration for bleeding in 6 patients, pericardial effusion in 9, and cerebral infarction, pleural effusion and pneumothorax each in 2 patients. One hundred and seventy-five patients (78.12%) were followed up, with a mean follow-up period of 15.7 +/- 13.1 months (range, 2 weeks to 65 months). One patient died from lower-limb embolism and renal dysfunction at 3 months postoperatively. Three patients died from postoperative anticoagulant accidents. The preoperative and postoperative mean left ventricular end-diastolic diameters were significantly different (68.1 mm +/- 9.4 mm, range: 54 to 112; vs 54.8 mm +/- 8.2 mm, range: 38 to 88; P < 0.001).

Aortic aneurysm without dissection or with chronic dissection should be operated if the diameter of the aneurysm is greater than 5 cm. Once a diagnosis of acute aortic root dissecting aneurysm is made, the patient should undergo surgery as soon as possible if the general condition permit.