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Total composite graft replacement of the ascending aorta and aortic valve
1Department of Cardiovascular Surgery, Osaka National Hospital, Japan.
Insights
Total composite graft replacement for ascending aorta and aortic valve is feasible with low operative mortality. Close follow-up is crucial due to potential anastomotic dehiscences, a late complication observed in some patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Surgery
Background:
- Annulo-aortic ectasia is a common indication for ascending aorta and aortic valve replacement.
- Aortic dissection and aortitis syndrome also necessitate complex aortic repair.
- Syphilitic aneurysms present a challenging surgical scenario for aortic valve and ascending aorta replacement.
Purpose of the Study:
- To evaluate the feasibility and outcomes of total composite graft replacement for the ascending aorta and aortic valve.
- To assess operative mortality and early/late complications associated with the procedure.
- To determine long-term survival and functional status in patients undergoing this complex aortic repair.
Main Methods:
- Ten patients underwent total composite replacement of the ascending aorta and aortic valve.
- Procedures included the original Bentall and DeBono technique and the modified Cabrol et al. technique.
- Patient demographics, indications, surgical techniques, and follow-up data were analyzed.
Main Results:
- No operative deaths or in-hospital complications were observed.
- Late complications occurred in two patients, including one death from hepatic failure and another intraoperative death.
- Eight survivors achieved New York Heart Association (NYHA) class 1 functional status at an average of 4.3 years postoperatively.
Conclusions:
- Total composite graft replacement is a feasible surgical option for ascending aorta and aortic valve pathologies with low operative mortality.
- The procedure requires vigilant long-term follow-up due to the risk of anastomotic dehiscences.
- Despite potential late complications, the majority of patients experience good functional recovery.
Abstract:
Ten patients (nine male and one female), ranging in age from 21 to 68 years, were operated on for total composite replacement of the ascending aorta and the aortic valve. Among them annulo-aortic ectasia was the most common indication (five patients), followed by annulo-aortic ectasia with aortic dissection (three patients), the aneurysm and aortic valve regurgitation associated with aortitis syndrome (one patient), and the syphilitic aneurysm and aortic valve regurgitation (one patient). In the first four patients, composite replacement was conducted according to the original procedure described by Bentall and DeBono (1986). The next six patients were treated according to the procedure modified by Cabrol et al. (1981). There were no operative deaths or complications during hospitalization. However, late complications occurred in two patients at 46 months and 15 months after surgery, respectively. Despite the repair on an urgent basis, one died of hepatic failure and the other died on the table with massive disruption. Eight late survivors remain in the New York Heart Association (NYHA) class 1 on an average of 4.3 years postoperatively. It is concluded that total replacement with a composite graft is feasible in all patients with low operative mortality, but this procedure needs a close follow-up because of the potential for anastomotic dehiscences.