Surgery for ascending aortic aneurysm with aortic regurgitation

We reviewed 22 consecutive patients undergoing surgery during 13 years from 1968 to 1981 for ascending aortic aneurysms associated with aortic regurgitation due primarily to idiopathic medionecrosis resulting in annuloaortic ectasia. Chronic aortic dissection was accompanied in 45% of the patients. The operative period was divided into 2 stages, the first from 1968 to 1976, and the second from 1977 to 1981. In the earlier period, the operative mortality was 42%, and it improved significantly to 0% (p less than 0.05) in the later period. The reasons for improved surgical results are 1) the employment of the Bentall operation with some technical modifications and 2) the use of better myocardial protection method with cold potassium cardioplegia. The postoperative hemodynamic and clinical improvements were significant. The left ventricular improved toward normal (p less than 0.05 and p less than 0.001). Operative survivors showed a clinical improvement from NYHA class 3 to 1.3 on an average. The actuarial survival rate at 6 years after operation was 64.3% in the entire series, and 71.1% in patients with the Bentall operation. In patients with type I aortic dissection, a false lumen remained patent after operation and may progress to cause late morbidity or mortality. Surgery should be performed earlier than aortic dissection takes place whenever feasible. The Bentall operation can now be performed with a low risk, and can improve the clinical and hemodynamic states and very possibly prolong the longevity of the patients.