[Composite valve graft replacement for aortic root aneurysm or dissection].
Fifty four patients who had aneurysms (n = 35) or dissections (n = 19) associated with aortic regurgitation underwent the replacement of the ascending aorta and aortic valve by composite valve graft during 15-year period between September 1976 and December 1991. Of these, 49 (90.7%) patients had an annuloaortic ectasia and 26 (48.1%) had the Marfan syndrome. The methods of coronary artery reattachment to the graft were as follows: direct reattachment (original Bentall's technique) in 45 patients, aortic button technique (Carrel's patch technique) in 6, Cabrol's technique in 2 and Piehler's technique in 1 patients. Seven patients with a DeBakey type I dissection had concomitant replacement of the aortic arch with an aid of selective cerebral perfusion. The overall hospital mortality rate was 12.9%, and it has significantly decreased to 6.7% since we adopted a cold cardioplegia, preclotting the graft with albumin autoclave technique and coronary artery reattachment using conventional over-and-over and interrupted mattress sutures with pledgets during the last 10-years. The mean duration of follow-up period was 58.6 months. The actuarial survival rate at 10 years for all patients was 76.4%; for those with dissection, 78.4%; and for patients with Marfan syndrome, 70.4%. Reoperation for the prosthesis-related complications was necessary in only one patient, although operations on the remainder of aorta were required in 5 patients. Actuarial freedom from these operations at 10 years was 74.1%, but it was 69.3% for the subgroup with Marfan syndrome. The present data indicates that composite valve graft technique is an useful method for patients with aortic root aneurysms or dissections.
Yamada
O
O
Department of Surgery (Section 2), Sapporo Medical College, Japan.
Kazui
T
T
Yamada
A
A
Koshino
T
T
Sakurada
T
T
Ikeda
K
K
Kawashima
T
T
Sasaki
A
A
Inoue
N
N
Komatsu
S
S
D000328:Adult; D000784:Aortic Dissection / Q000601:surgery*; D001011:Aorta / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D001807:Blood Vessel Prosthesis; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000601:surgery; D008722:Methods; D008875:Middle Aged; D015996:Survival Rate