[Surgery FOR annulo-dystrophic disease of the ascending aorta. Apropos of 203 cases].
From April 73 to June 94, 203 patients (167 men, 36 women) aged from 10 to 74 years (mean 44.8 +/- 15) underwent ascending aortic replacement with a composite graft for: dystrophic aneurysm (AN) (130 cases, 64.5%), chronic dissection (CD) (35 cases, 17.2%), type A acute dissection (AD) (38 cases, 19%). Forty-six patients (22.6%) suffered from Marfan syndrome (24 AN, 13 AD, 9 CD). Thirty patients (14.7%) had undergone a previous cardiac or aortic operation. The ascending aortic replacement was extended to the transverse arch in 28 patients (14%). A mechanical valve was used in 193 cases (95%). The technique of coronary reattachment has varied with time and according to the aortic lesions. The classic "Bentall" technique was used in 87 patients (43%), the "button" technique in 74 (36%), the "Cabrol" technique in 26 (13%) and a "mixed" technique in 16 cases (8%). The hospital mortality rate was 7.3% (15/203) (AN: 2.3%, CD: 11.4%, AD: 21%). The only predictors of hospital death were emergency AD (p < 0.03) and arch replacement (p < 0.02). Mean follow-up was 46 +/- 10 months (2-246). The overall long-term survival rate was (Kaplan Meier) 89 +/- 6% at 1 year, 77.9% at 5 years, 67.7 +/- 12% at 10 years and 61.3% +/- 15% at 12 years. The 10 years survival rate is significantly higher in patients with AN (77.8 +/- 11%) than in those with AD (61.6 +/- 17%) (Log.rank: p < 0.01). The late survival rate is also significantly higher after the "button" or Bentall reimplantation that after the "Cabrol" or "mixed" methods (90 +/- 5% in the "button" group and 88.7 +/- 6%, 83.8 +/- 9% and 76.6 +/- 12% in the "Bentall" group vs 80 +/- 18%, 63 +/- 21% and 58 +/- 35% in the "Cabrol" group at 1, 5 and 8 years, respectively). In conclusion, ascending aortic replacement with a composite graft is a safe procedure especially when performed electively in patients with dystrophic aneurysm or Marfan syndrome. The technique of coronary reimplantation has a significant on the long-term results.
Guilmet
D
D
Service de chirurgie cardiaque et vasculaire, CMC Foch, Suresnes.
Bachet
J
J
Termignon
J L
JL
Brodaty
D
D
Dreyfus
G
G
Goudot
B
B
Piquois
A
A
Dubois
C
C
de Lentdecker
P
P
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects / Q000379:methods*; D002648:Child; D003331:Coronary Vessels / Q000601:surgery; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008382:Marfan Syndrome / Q000150:complications; D008875:Middle Aged; D012086:Reoperation; D012307:Risk Factors; D015996:Survival Rate
Chirurgie de la maladie annulo-dystrophique de l'aorte ascendante. A propos de 203 patients.