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Replacement of the ascending aorta and aortic valve with a composite graft. Results in 86 patients
Insights
Composite graft replacement of the ascending aorta and aortic valve is a safe and effective surgical option. This procedure demonstrates favorable long-term outcomes, with high survival and low reoperation rates for aortic conditions.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Surgery
Background:
- Anuloaortic ectasia and aortic dissection are common indications for ascending aorta and aortic valve replacement.
- Previous techniques like supracoronary graft replacement have known complications, such as sinus of Valsalva aneurysms.
Purpose of the Study:
- To evaluate the safety and efficacy of composite graft replacement of the ascending aorta and aortic valve.
- To assess long-term outcomes, including mortality, reoperation rates, and survival, for this surgical technique.
Main Methods:
- Retrospective review of 86 patients undergoing composite graft replacement of the ascending aorta and aortic valve between January 1974 and December 1979.
- Analysis of hospital mortality, reoperation rates, actuarial survival, and complications such as pseudoaneurysms.
Main Results:
- Hospital mortality was 5%, associated with preoperative functional status and intraoperative ischemia duration.
- Six percent of hospital survivors required reoperation on the ascending aorta.
- Three-year actuarial survival was 81% overall, 88% for anuloaortic ectasia, and 83% for aortic dissection.
- Pseudoaneurysms were observed in 5 of 16 patients undergoing postoperative angiography, with one requiring reoperation.
Conclusions:
- Composite graft replacement is a satisfactory alternative to supracoronary techniques, effectively excluding aneurysmal tissue.
- This method is advantageous for patients with anuloaortic ectasia and cephalad displacement of coronary ostia.
- It is a suitable option for selected patients with acute/chronic aortic dissection and sinus of Valsalva aneurysms.
Abstract:
We reviewed our entire experience with composite graft replacement of the ascending aorta and aortic valve during a 63 month interval ending in December, 1979. Anuloaortic ectasia was the most common indication for operation, followed by aortic dissection (acute and chronic). Hospital mortality was 5% and was related to the preoperative functional status and the duration of intraoperative myocardial ischemia. Reoperation on the ascending aorta for reasons other than postoperative hemorrhage was required in five of the 82 hospital survivors (6%). By actuarial analysis, 90% of hospital survivors were free of any reoperation on the ascending aorta or aortic valve three years postoperatively, and 93% were free of reoperation related specifically to the composite graft. Pseudoaneurysms at the coronary ostia or distal aortic anastomosis were observed in five of 16 patients having postoperative angiography. One of the five patients has required reoperation. Follow-up has averaged 23.5 months (range: 0.2-60 months). Three year actuarial survival for the 86 patients was 81%, for 44 patients with anuloaortic ectasia was 88%, and for 31 patients with aortic dissection was 83%. Composite graft replacement of the ascending aorta and aortic valve is a satisfactory alternative to supracoronary graft replacement and aortic valve replacement. It offers the advantage of excluding all aneurysmal tissue from the aortic anulus to the innominate artery, thereby eliminating the potential for later development of aneurysms of the sinuses of Valsalva, a known complication of the supracoronary technique. It is the method of choice for patients with anuloaortic ectasia and cephalad displacement of the coronary ostia. It is suitable for many patients with acute or chronic dissection and for patients with sinuses of Valsalva aneurysms following previous operations on the ascending aorta or aortic valve.