title: Composite aortic root replacement with direct coronary artery implantation.
abstract: BACKGROUND
  Composite aortic root replacement is accepted treatment for aneurysms of the ascending aorta involving the root with aortic valve regurgitation, but controversy continues regarding the best technique of operation. We excise the aneurysm, implant a composite valve graft, directly attach the coronary arteries to the aortic graft, and make the distal anastomosis to the divided aorta.
  
  
  METHODS
  We reviewed the records and collected complete follow-up data on 110 consecutive patients having composite aortic root replacement with this technique from 1979 to 1995.
  
  
  RESULTS
  Average age was 54 years. Marfan's syndrome was present in 22 patients, acute dissections in 26, chronic dissections in 11, and active endocarditis in 13. Operative characteristics were: 25 emergency procedures, 33 urgent procedures, 52 elective procedures, 24 reoperations, and 19 with coronary artery bypass grafting. Hospital death occurred in 8 patients (7.3%). Multivariate predictors of hospital death were postoperative renal failure and acute dissection. Actuarial survival was 70% at 10 years (standard error, 5%). Multivariate predictors of total mortality were porcine valve, Björk-Shiley valve, preoperative stroke, reoperation on a composite valve graft, and coronary artery bypass grafting. Only 3 patients required late reoperation, all for valve dysfunction. Actuarial freedom from reoperation on the aortic root was 97.3% (standard error, 1.9%) at 10 years. Late echocardiograms in 47 patients showed no anastomotic aneurysms.
  
  
  CONCLUSIONS
  Composite aortic root replacement with direct coronary implantation is effective and durable treatment for a variety of aortic pathologic conditions in elective and emergency situations.
authors.affiliation: Cardiac Surgical Unit, Massachusetts General Hospital, Boston 02114, USA.
authors.forename: A D
authors.initials: AD
authors.lastname: Hilgenberg
authors.forename: C W
authors.initials: CW
authors.lastname: Akins
authors.forename: D L
authors.initials: DL
authors.lastname: Logan
authors.forename: G J
authors.initials: GJ
authors.lastname: Vlahakes
authors.forename: M J
authors.initials: MJ
authors.lastname: Buckley
authors.forename: J C
authors.initials: JC
authors.lastname: Madsen
authors.forename: D F
authors.initials: DF
authors.lastname: Torchiana
mesh_terms: D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000401:mortality / Q000601:surgery; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000401:mortality / Q000601:surgery; D001158:Arteries / Q000601:surgery; D001705:Bioprosthesis; D001807:Blood Vessel Prosthesis; D002423:Cause of Death; D003331:Coronary Vessels / Q000601:surgery*; D004696:Endocarditis / Q000150:complications; D005260:Female; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012307:Risk Factors; D015996:Survival Rate