Related Experiment Videos
Chronic disease of the ascending aorta. Surgical treatment and long-term results
1Department of Thoracic and Cardiovascular Surgery, Pitie's Hospital, Paris, France.
Insights
This study on ascending aorta disease found that composite valve graft replacement with coronary artery reattachment offers good long-term survival and low reoperation rates, especially for complex cases.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Disease Research
Background:
- Chronic disease of the ascending aorta affects a significant patient population.
- Previous operations and aortic dissection are common in patients requiring ascending aorta surgery.
- Marfan's disease is present in a small percentage of patients with ascending aorta conditions.
Purpose of the Study:
- To evaluate the long-term outcomes of surgical interventions for chronic ascending aorta disease.
- To identify risk factors for operative and late mortality in ascending aorta surgery.
- To assess the efficacy and reoperation rates of composite valve graft replacement with coronary artery reattachment.
Main Methods:
- Retrospective analysis of 339 patients undergoing elective ascending aorta surgery between 1979 and 1991.
- Surgical techniques included tubular graft replacement, graft and valve replacement, and composite valve graft replacement with coronary artery reattachment.
- Multivariate analysis and actuarial methods were used to determine risk factors and survival rates.
Main Results:
- The 30-day mortality rate was 7.6%.
- Operative risk factors included concomitant coronary artery bypass grafting, advanced age, aortic valve regurgitation, and prior cardiac surgery.
- Nine-year survival was 59.6%, with lower survival in patients undergoing aortic arch reconstruction (56%) compared to those without (67%).
- Actuarial freedom from reoperation was 90% at 9 years, with only one reoperation needed for composite valve graft issues.
Conclusions:
- Composite valve graft replacement with coronary artery reattachment is a safe and effective technique for chronic ascending aorta disease, particularly in complex cases.
- Aortic arch reconstruction is associated with reduced long-term survival.
- The described surgical approach demonstrates favorable long-term results and low reoperation rates.
Abstract:
Between January 1979 and December 1991, we operated on 339 patients for chronic disease of the ascending aorta. The operation was elective in all. Endocarditis and its sequelae have been excluded. Thirty-one patients had a previous operation on the ascending aorta or the aortic valve; 268 patients had aneurysms of the ascending aorta without dissection; 72 had chronic aortic dissections, of whom 33 had a preexistent aneurysm. The patients included 272 men and 67 women. Mean age was 53.58 +/- 7 years. Eight percent of the patients had clinical stigmata of Marfan's disease. A tubular graft replacement was used in 7 patients, a tubular graft and valve replacement in 72 patients, and a composite valve graft replacement with reattachment of the coronary arteries using a 8 mm Dacron graft was performed in 260 patients. Concomitant procedures were used in 74 patients: coronary artery bypass grafts in 25, mitral valve replacement in 9, and aortic arch reconstruction in 40. The 30-day mortality rate was 7.6% (n = 26). For the whole group, multivariate analysis using stepwise logistic regression showed that operative risk factors were concomitant coronary artery bypass grafting, age (increased), aortic valve regurgitation, and previous cardiac surgery. Follow-up was conducted in 303 patients, and risk factors for late mortality were studied. Long-term survival was 59.6% +/- 3.7% at 9 years. It was 67% +/- 3.5% at 9 years for patients without aortic arch reconstruction and 56% +/- 4.5% for patients with aortic arch reconstruction (p = 0.0018). Reoperation was needed in 14 patients. Actuarial freedom from reoperation was 90% +/- 0.2% at 9 years for all the patients. Only one patient with composite valve graft replacement and reattachment of the coronary arteries had required reoperation for problems related to this procedure. This technique is used routinely by our team, especially in patients with large chronic aneurysms, dissected or not, and in those who had previous operations. The long-term results are good.