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Replacement of the ascending aorta with composite valve grafts: long term results
1Department of Cardiothoracic Surgery, Sahlgren's Hospital, Göteborg, Sweden.
Insights
Composite graft replacement of the aortic root shows good long-term survival. Careful follow-up is essential for patients with Marfan syndrome or aortic dissection to improve outcomes.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Long-term survival after aortic root replacement is improving.
- Progression of disease in the remaining aorta (dissection or atherosclerosis) is the most common cause of late death.
- This study reviews clinical experience with composite graft replacement of the aortic root.
Purpose of the Study:
- To review clinical experience with composite graft replacement of the aortic root.
- To assess long-term results of this surgical procedure.
- To identify risk factors for mortality and reoperation.
Main Methods:
- 126 patients underwent aortic root replacement with a composite-graft prosthesis over 12 years.
- Surgical technique involved resection of the ascending aorta and aortic valve with graft anastomosis.
- Follow-up was complete to July 1995, with uni- and multivariate analysis performed.
Main Results:
- 18% (23 patients) died within 30 days, primarily from heart failure, with 16 cases of aortic dissection.
- Heart failure was the most common cause of death during follow-up.
- 13 late reoperations were performed in 12 patients, six with Marfan's syndrome, with 30-day mortality at reoperation being 30%.
Conclusions:
- Composite graft replacement of the aortic root offers good long-term results, with a five-year survival of 67% (or 75% excluding 30-day mortality).
- Careful follow-up of patients with Marfan's syndrome and/or aortic dissection is mandatory.
- This approach provides a viable option for aortic root pathologies, emphasizing the need for vigilant post-operative monitoring.
Background And Aims Of The Study:
Long term survival after replacement of the aortic root is improving. The most common cause of late death is progression of disease in the remaining aorta (dissection or atherosclerosis). The purpose of this study was to review our clinical experience with composite graft replacement of the aortic root with special reference to long term results.
Materials And Methods:
One hundred twenty-six patients (mean age: 53 years) with different pathologies of the ascending aorta underwent aortic root replacement with a composite-graft prosthesis over a 12-year period. Twenty-three patients had previously undergone cardiovascular surgery. The surgical technique included resection of the ascending aorta with the aortic valve and end-to-side anastomosis between full-thickness buttons of the aortic wall with the coronary ostia and the graft. One or more associated cardiovascular procedures were performed in 24 cases. Long term follow up to July 1995 is complete. Uni- and multivariate analysis were performed to identify risk-factors for early and late mortality and reoperation.
Results:
Twenty-three patients died during the first 30 days (18%). Sixteen of them had aortic dissection. The most common cause of early death was heart failure. Twenty-three patients died during the follow up time with heart failure, again, being the most common cause of death. Thirteen late reoperations on the composite-graft or the remaining aorta were performed in 12 patients, six of whom had Marfan's syndrome. The 30-day mortality at reoperation was 30%.
Conclusions:
This surgical option offers good long term results with a five-year actuarial survival of 67% or 75% when the 30-day mortality is excluded. Careful follow up of patients with Marfan's syndrome and/or aortic dissection is mandatory to increase the long term survival.