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Ascending aortic aneurysms: composite conduit replacement
G Ottino1, L Biratta, S Del Ponte
1Cardiovascular Surgery Department, University of Torino Medical School, Torino, Italy.
Insights
Composite aortic replacement improves survival for ascending aortic aneurysms. This surgical technique is beneficial, even for high-risk patients with dissecting or chronic aortic aneurysms.
Area of Science:
- Cardiovascular Surgery
- Aortic Aneurysm Research
- Surgical Outcomes
Background:
- Ascending aortic aneurysms, including dissecting and chronic types, pose significant mortality risks.
- Surgical intervention is often necessary but carries inherent risks.
- Coronary reimplantation during aortic valve and ascending aorta replacement is a complex procedure.
Purpose of the Study:
- To evaluate the efficacy and survival rates of composite replacement for ascending aortic aneurysms.
- To assess outcomes in patients with both dissecting and chronic aortic aneurysms undergoing this procedure.
- To identify potential benefits for high-risk patient populations.
Main Methods:
- A cohort of 26 patients underwent composite replacement of the ascending aorta and aortic valve with coronary reimplantation between 1980 and 1984.
- Patients were categorized into dissecting aneurysm (Type I and II) and chronic aneurysm subgroups.
- Follow-up included echocardiography and computed tomography scanning; survival rates were analyzed actuarially.
Main Results:
- Hospital mortality was 35.7% for dissecting aneurysms and 16.6% for chronic aneurysms.
- The 4-year actuarial survival rate was 58.3% overall (83.3% for chronic, 42.3% for dissecting aneurysms).
- Late survivors experienced no paravalvular leaks, new dissections, or thromboembolisms, though complications like perigraft hematomas occurred.
Conclusions:
- Composite conduit replacement of the ascending aorta is a viable surgical option.
- The procedure can improve survival rates in patients with ascending aortic aneurysms.
- This technique may be particularly beneficial for high-risk individuals, including those with aortic dissections.
Abstract:
From July 1980 to February 1984, 26 patients underwent composite replacement of ascending aortic aneurysm and aortic valve with coronary reimplantation. This group included 14 patients with dissecting aneurysm (ten and four respectively, belonging to Types I and II), and 12 patients with chronic aneurysm (six atherosclerotic aneurysms, two Marfan's syndrome and four annuloaortic ectasia cases). Hospital mortality was 35.7% (5/14) in the dissection subgroups and 16.6% (2/12) in the chronic aneurysm subgroup (difference NS). No operative risk factor was recognized. The 19 survivors have been followed up for a total of 393 patient-months (range 5 to 49 months). Controls included echocardiography and computed tomography scanning. Two patients died because of rupture of a persistently dissected aorta; another patient died of an unknown cause. Total actuarial survival rate at 4 years was 58.3 +/- 10.4% (83.3 +/- 10.7% for chronic aneurysms and 42.3 +/- 13.4% for dissecting aneurysms). Among late survivors, there were no paravalvular leaks, new dissections, or thromboembolisms, although two perigraft hematomas and a persistent dissection were later disclosed. When appropriate, composite conduit replacement of the ascending aorta can increase the survival rate, and can also be useful in high-risk patients.
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