Current practice in Marfan's syndrome and annulo-aortic ectasia: aortic root replacement with a composite graft over a twenty-year period.
BACKGROUND
From October 1973 to December 1995, 251 patients (204 male, 47 female) aged from 10 to 75 years (mean: 46.6 +/- 15) underwent an ascending aortic replacement with a composite graft for: dystrophic aneurysm (AN), 168 cases (66.9%); chronic dissection (CD), 36 cases (14%); and type A acute dissection (AD), 48 cases (19.1%). Fifty-one patients (20.3%) suffered from Marfan's disease (25 AN, 17 AD, 9 CD). Thirty-seven patients (14.7%) had undergone a previous cardiac or aortic operation. The ascending aortic replacement was extended to the transverse arch in 31 patients (12.3%). A mechanical valve was used in 233 patients (92.8%). The classic "Bentall" technique was used in 87 patients (34.6%), the "button" technique in 121 patients (48.2%), the "Cabrol" technique in 26 patients (10.3%) and a "mixed" technique in 17 patients (6.2%).


RESULTS
The hospital mortality accounts for 7.2% (18 out of 251) (AN: 4 out of 68, 2.3%, CD: 4 out of 36, 11.1%, AD: 9 out of 48, 18.7%). When emergencies are considered, the hospital mortality is 12 out of 54 (22.2%) versus 6 out of 197 (3%) in elective procedures. The predictors of hospital death were emergency, AD (p < 0.03) and arch replacement (p < 0.02). Mean follow up is 38 +/- 15 months (4-262). The overall long term survival rate is (Kaplan Meïer): 92 +/- 6% at one year, 77.9% +/- 9% at 5 years, 67.7 +/- 12% at 10 years, and 61.3 +/- 15% at 12 years. The 10-year survival rate is significantly higher in patients with AN (93 +/- 6%) than in patients with AD (61.6 +/- 17%) (p < 0.01). The late survival rate is also significantly higher after the "button" (93.8 +/- 5%) or Bentall's reimplantation (88.7 +/- 6%, 83.8 +/- 9%, and 76.6 +/- 12%) than after the "Cabrol" procedure (80 +/- 18%, 63 +/- 21% and 58 +/- 35%) at 1, 5, and 8 years, respectively.


CONCLUSIONS
Ascending aortic replacement with a composite graft is a safe procedure, especially when performed electively in patients with dystrophic aneurysm or Marfan's disease. The technique of coronary reimplantation has a significant influence of the long-term results, with the reimplantation of choice being the "button" technique. The "Cabrol" technique must be used when the "button" or the "Bentall" reimplantation is not feasible.
Bachet
J
J
Service de Chiurgie Cardio-Vasculaire, Hospital Foch, Universite Rene Descartes, Suresnes, France.
Goudot
B
B
Dreyfus
G
G
Termignon
J L
JL
Banfi
C
C
Piquois
A
A
Brodaty
D
D
Dubois
C
C
Delentdecker
P
P
Guillet
D
D
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001011:Aorta / Q000601:surgery; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D001807:Blood Vessel Prosthesis; D002648:Child; D002908:Chronic Disease; D005260:Female; D006350:Heart Valve Prosthesis; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods