Surgery for ascending aortic aneurysm with aortic regurgitation

Area of Science:

• Cardiovascular Surgery
• Aortic Aneurysm Research
• Medical Technology Advancement

Background:

• Ascending aortic aneurysms with aortic regurgitation, often due to idiopathic medionecrosis and annuloaortic ectasia, pose significant surgical challenges.
• Chronic aortic dissection was present in 45% of patients, complicating surgical management.
• Early surgical approaches (1968-1976) had a high operative mortality rate of 42%.

Purpose of the Study:

• To evaluate the evolution of surgical techniques and outcomes for ascending aortic aneurysms associated with aortic regurgitation.
• To assess the impact of the Bentall operation and improved myocardial protection on surgical results.
• To analyze long-term survival and clinical improvements in patients undergoing surgical repair.

Main Methods:

• Review of 22 consecutive patients undergoing surgery for ascending aortic aneurysms between 1968 and 1981.
• Comparison of outcomes between two operative periods: 1968-1976 and 1977-1981.
• Application of the Bentall operation with technical modifications and cold potassium cardioplegia for myocardial protection.

Main Results:

• Operative mortality significantly decreased from 42% in the earlier period to 0% in the later period (p < 0.05).
• Postoperative hemodynamic and clinical status improved significantly, with left ventricular function normalizing (p < 0.05 and p < 0.001).
• Actuarial survival at 6 years was 64.3% overall and 71.1% for patients receiving the Bentall operation.

Conclusions:

• The Bentall operation, coupled with enhanced myocardial protection, has dramatically improved surgical outcomes for ascending aortic aneurysms with aortic regurgitation.
• Early surgical intervention is recommended, particularly before significant aortic dissection progression.
• The procedure offers low risk, improves patient hemodynamics and clinical status, and potentially prolongs longevity.