title: Surgical treatment of aneurysms of the ascending aorta: early experience with the sinus-shaped composite dacron graft.
abstract: This paper reviews the early and late results of 36 operations for aneurysms of the ascending aorta. Cystic medial necrosis was the predominant cause of aneurysm formation (56%), followed by arteriosclerosis (25%), previous aortotomy (11%) and syphilitic aortitis (8%). Dissection was encountered in 42%. The ascending aorta was replaced by a tubular Darcron graft in 26 patients, whereas 10 underwent aneurysmorrhaphy. Additional procedures were aortic valve replacement (27), resuspension of the aortic commissures (4) and coronary ostial implantation into sinus-shaped composite Dacron graft (4). Hospital mortality (0--18 days) was 8/36 patients (22%), but higher with cystic medial necrosis (30%), dissection (33%), duration of ECC greater than 180 minutes (38%), graft replacement (44%), emergency operation (45%) and heart volume greater than 900 ml/m2 BSA (50%). Late mortality (average 3 years) was 29%, but higher with cystic medial necrosis (33%), following aortic valve replacement (36%) and during anticoagulation (47%). Late cumulative survival (average 3 years) was 47% for the entire series, but only 33% in the presence of cystic medial necrosis. The poor overall prognosis for patients with cystic medial degeneration was closely related to a high incidence of fatal anastomotic complications and late deaths from cerebral haemorrhage during anticoagulation. Radical exclusion of the diseased aortic wall and omission of long-term anticoagulation are therefore desirable in order to lower the mortality rate. Surgery concerns the aneurysm per se, the aortic incompetence and the coronary ostia. The sinus-shaped composite graft with a Björk-Shiley prosthesis at its base appears to be a promising device for such a procedure, which should be performed electively, following early diagnosis in order to prevent dissection and emergency operations.
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001011:Aorta / Q000601:surgery; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D002648:Child; D005112:Extracorporeal Circulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013548:Sweden; D013923:Thromboembolism / Q000209:etiology; D013997:Time Factors