Dealing with dilated ascending aorta during aortic valve replacement: advantages of conservative surgical approach.
Five to fifteen percent of patients undergoing aortic valve replacement (AVR) will have an ascending aortic aneurysm requiring a concomitant surgical procedure. On the other hand, a dilated ascending aorta is known to be a potential source of complications after AVR. From 1972 to 1988, 2278 AVR, either isolated or combined with a second cardiac procedure, were performed in our institution. In the same time interval, a dilated ascending aorta was treated in additional 291 consecutive patients during AVR. Three different surgical options were employed: aortic remodelling and external wall support in 164 patients (56.4%), composite graft replacement in 81 patients (27.8%) and a supracoronary graft in 46 patients (15.8%). Early mortality was 4.8%. Aortic remodelling plus external wall support had the lowest early mortality (1.8%) and the best 8-year survival (89.6%). Supracoronary grafting had a higher early mortality (6.4%) and lower 8-year survival (73.2%). The results of the composite graft were least favourable: early mortality was 9.8% and 8-year survival 76.5%. The results point out the necessity for instituting the appropriate surgical procedure for a dilated ascending aorta during AVR. They show that conservative aortic surgery with preservation of endothelial lining gives excellent early and late results.
Carrel
T
T
Clinic for Cardiovascular Surgery, Zurich, Switzerland.
von Segesser
L
L
Jenni
R
R
Gallino
A
A
Egloff
L
L
Bauer
E
E
Laske
A
A
Turina
M
M
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000368:Aged; D001011:Aorta / Q000473:pathology* / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000401:mortality / Q000601:surgery; D001021:Aortic Valve / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D004108:Dilatation, Pathologic / Q000150:complications / Q000401:mortality / Q000601:surgery; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged