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[Operative results of simultaneous replacement of aortic valve and ascending aorta]
1Department of Thoracic and Cardiovascular Surgery, Asahikawa City Hospital.
Insights
Surgical repair of ascending aortic aneurysms with aortic valve regurgitation showed no hospital mortality using Bentall
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Aneurysm Repair
Context:
- Ascending aortic aneurysms with aortic valve regurgitation present significant surgical challenges.
- Various techniques, including Bentall's, Cabrol's, and Carrel patch, are used for repair.
- Intraoperative bleeding and late complications are key concerns in these procedures.
Purpose:
- To evaluate the efficacy and safety of different surgical techniques for ascending aortic aneurysm and aortic valve regurgitation.
- To compare outcomes, including hospital mortality, late complications, and functional improvement, among Bentall's, Cabrol's, and Carrel patch procedures.
- To assess the effectiveness of specific surgical maneuvers, such as Cabrol's trick and Carrel patch technique, in managing intraoperative bleeding and ensuring secure anastomosis.
Summary:
- Six surgical procedures were performed: Bentall's (6), Cabrol's (6), modified Cabrol's (3), and Carrel patch (2).
- No hospital mortality was observed. Late complications included graft dehiscence (1) and distal aortic arch false lumen enlargement (1).
- All surviving patients demonstrated improved cardiac function and clinical status. The Carrel patch technique provided secure coronary anastomosis and definitive hemostasis, while Cabrol's trick aided hemostatic control.
Impact:
- The Carrel patch technique is highlighted for its ability to achieve secure coronary anastomosis and definitive hemostasis.
- Cabrol's trick offers effective hemostatic control during complex aortic surgeries.
- Despite potential complications, these surgical interventions lead to improved patient cardiac function and clinical outcomes.
Abstract:
As a surgical treatment of ascending aortic aneurysm with aortic valve regurgitation, we employed Bentall's procedure in 6 cases, Cabrol's procedure in 6 cases, Cabrol's procedure in 3 cases and Carrel patch technique in 2 cases. No hospital mortality was recorded. Late complications were noted in 2 patients. A graft dehiscence of the anastomosis of the right coronary artery occurred in 1 patient with Cabrol's procedure, 3 months postoperatively. In another patient with Bentall's procedure, enlargement of the dissected false lumen at the distal aortic arch necessitated surgical repair in other hospital, 4 years and 4 months after primary repair. All of the surviving patients showed improvement in cardiac function and their clinical status. We have frequently experienced troublesome intraoperative bleeding in applying Bentall's procedure and Cabrol's procedure also. However, hemostatic control was permitted by Cabrol's trick. We are satisfied with the results obtained by Carrel patch technique. This technique facilitates secure coronary anastomosis and definitive hemostasis is attained.