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The ascending aortic aneurysm: replacement or repair?
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This study compared four surgical methods for ascending aortic aneurysms. Reduction aortoplasty with a synthetic net showed lower complication rates for specific patient groups, offering a viable alternative.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Aneurysm Treatment
Background:
- Ascending aortic aneurysms encompass various pathologies including dissection, dilatation, and inflammatory disease.
- Surgical intervention is crucial for managing ascending aortic aneurysms.
Purpose of the Study:
- To retrospectively compare the outcomes of four distinct surgical procedures for ascending aortic aneurysms.
- To identify the most suitable operative method based on aneurysm type and patient characteristics.
Main Methods:
- Analysis of 100 patients operated on between 1971 and 1980 for ascending aortic aneurysms.
- Four surgical techniques were evaluated: repair and reduction aortoplasty, nylon-reinforced reduction aortoplasty, supracoronary graft replacement, and composite graft replacement.
- Retrospective comparative analysis of early and late mortality and complication rates.
Main Results:
- Overall early mortality was 10% and late mortality was 12% after a mean follow-up of 45 months.
- Nylon-reinforced reduction aortoplasty demonstrated a lower complication rate (cerebrovascular accidents, myocardial infarction) compared to graft replacements in selected patients.
- Supracoronary graft replacement is preferred for acute/chronic dissection with an intact aortic root.
- Composite graft replacement is the procedure of choice for annuloaortic ectasia, dilated sinus of Valsalva, and Marfan's syndrome.
Conclusions:
- Nylon-reinforced reduction aortoplasty is a suitable method for ascending aortic aneurysms without dissection or inflammatory disease, provided careful attention is paid to anchor stitches.
- Graft replacement techniques offer distinct advantages for specific aortic pathologies, guiding surgical decision-making.
Abstract:
Between 1971 and 1980, 100 patients underwent operation for ascending aortic aneurysm. Acute dissection was present in 29, chronic dissection in 11; 56 had dilatation only, and 4 had inflammatory disease of the ascending aorta. Four different operative procedures were applied independent of the type of disease: repair and reduction aortoplasty (21), reduction aortoplasty reinforced by nylon net (17), supracoronary graft replacement (42), and composite graft replacement with reimplantation of both coronary ostia (20). Early mortality was 10%, and late mortality was 12% after a mean follow-up of 45 months. Retrospective comparative analysis of the four operative methods led to the following conclusion: reduction aortoplasty supported by a tightly wrapped synthetic net is a suitable method in patients with a normal sinus of Valsalva and without dissection or inflammatory disease. Particular attention needs to be drawn to the proximal anchor stitches to avoid late net displacement. Compared with supracoronary or composite graft replacement, this method carried a lower complication rate, particularly in regard to cerebrovascular accidents and myocardial infarction. For patients with acute and chronic dissection with intact aortic root, supracoronary graft replacement is preferred, whereas in those with annuloaortic ectasia with dilated sinus of Valsalva and in all patients with Marfan's syndrome, composite graft replacement has become the procedure of choice.