[Immediate and long-term results of replacement of the ascending aorta in aneurysm or dissection].
Between April 1974 and November 1992, 181 patients were operated for aneurysm (106) or dissection (75) of the ascending aorta. Eighty patients had replacement with a valvular conduit with reimplantation of the coronary arteries (Bentall procedure), 48 had aortic valve replacement with replacement of the supra-coronary ascending aorta and 53 underwent isolated replacement of the ascending aorta. Twenty-nine patients (16%) died in the postoperative period, mainly of myocardial or neurological complications. Univariate statistical analysis completed by logistic regression analysis revealed the following predictive factors of early death: NYHA Stage IV, angina, reoperation for haemorrhage or tamponade (all < 0.05). All surviving patients were followed up (total follow-up: 788 years; mean: 62 months; range: 1 to 181 months). There were 20 secondary deaths, 40% of which were related to complications of aortic valve replacement. The 5 and 9 year survivals were 76 and 70% respectively, perioperative mortality included, and 89% of patients were in NYHA functional Stage I. Analysis of survival data did not reveal any predictive factor of secondary death. Eight patients were reoperated at long-term. The operative mortality of replacement of the ascending aorta remains high, especially in cases of dissection. The long-term results seem excellent with a low reoperation rate. Late mortality seems mainly due to complications of aortic valve replacement.
Corbineau
H
H
Clinique chirurgicale cardiovasculaire et thoracique, hôpital Pontchaillou, CHU, Rennes.
Logeais
Y
Y
Chaperon
J
J
Rioux
C
C
Leguerrier
A
A
Lecheaux
D
D
Langanay
T
T
Sevray
B
B
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001011:Aorta / Q000601:surgery; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve; D001807:Blood Vessel Prosthesis / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors
Résultats immédiats et éloignés du remplacement de l'aorte ascendante pour anévrysme ou dissection.