Related Experiment Videos
[Immediate and long-term results of replacement of the ascending aorta in aneurysm or dissection]
H Corbineau1, Y Logeais, J Chaperon
1Clinique chirurgicale cardiovasculaire et thoracique, hôpital Pontchaillou, CHU, Rennes.
Insights
Ascending aorta surgery for aneurysms and dissections has high early mortality, but long-term survival is excellent. Late deaths are primarily linked to aortic valve replacement complications.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Surgery
Context:
- Ascending aorta aneurysms and dissections require complex surgical intervention.
- Surgical techniques include the Bentall procedure, supra-coronary ascending aorta replacement, and isolated ascending aorta replacement.
- Perioperative outcomes and long-term results are critical for evaluating surgical efficacy.
Purpose:
- To evaluate the early and late outcomes of surgical repair for ascending aorta aneurysms and dissections.
- To identify predictive factors for early and late mortality.
- To assess the long-term survival and reoperation rates after ascending aorta replacement.
Summary:
- This study analyzed 181 patients undergoing ascending aorta surgery (aneurysm or dissection) between 1974 and 1992.
- Early mortality was 16%, with NYHA Stage IV, angina, and reoperation for hemorrhage/tamponade as predictors.
- Long-term survival was 76% at 5 years and 70% at 9 years, with late deaths mainly from aortic valve complications.
Impact:
- The study highlights the significant risks associated with ascending aorta surgery, particularly in dissection cases.
- It demonstrates excellent long-term survival and a low reoperation rate, suggesting good functional recovery.
- Findings emphasize the need for careful management of aortic valve complications to improve late outcomes.
Abstract:
Between April 1974 and November 1992, 181 patients were operated for aneurysm (106) or dissection (75) of the ascending aorta. Eighty patients had replacement with a valvular conduit with reimplantation of the coronary arteries (Bentall procedure), 48 had aortic valve replacement with replacement of the supra-coronary ascending aorta and 53 underwent isolated replacement of the ascending aorta. Twenty-nine patients (16%) died in the postoperative period, mainly of myocardial or neurological complications. Univariate statistical analysis completed by logistic regression analysis revealed the following predictive factors of early death: NYHA Stage IV, angina, reoperation for haemorrhage or tamponade (all < 0.05). All surviving patients were followed up (total follow-up: 788 years; mean: 62 months; range: 1 to 181 months). There were 20 secondary deaths, 40% of which were related to complications of aortic valve replacement. The 5 and 9 year survivals were 76 and 70% respectively, perioperative mortality included, and 89% of patients were in NYHA functional Stage I. Analysis of survival data did not reveal any predictive factor of secondary death. Eight patients were reoperated at long-term. The operative mortality of replacement of the ascending aorta remains high, especially in cases of dissection. The long-term results seem excellent with a low reoperation rate. Late mortality seems mainly due to complications of aortic valve replacement.