Composite graft replacement of the aortic root: long-term results, incidence of reoperations.
BACKGROUND
Long-term results after composite graft replacement of the aortic root may depend on the insertion technique.


METHODS
181 consecutive patients (mean age 53 years; 153 men) operated on between 1983 and 1993 were studied. Indications for surgery were annuloaortic ectasia (n=98), acute aortic dissection (n = 46), other indications (n = 12), and various indications after previous aortic valve replacement (n = 25). Mean follow-up was 28 months. The open-button technique was performed in 74 patients (41 %) and the Bentall inclusion technique in 107 patients (59%), with a Cabrol shunt to the right atrium in 16 patients.


RESULTS
Overall survival was 75% after 7 years, significantly decreased in acute aortic dissection (p = 0.0019) and without difference between the two surgical techniques (p = 0.3166). Reoperation-free survival was 69% at 7 years and significantly decreased after acute dissection (p = 0.0421 ). Pseudoaneurysm formation only occurred in 3 patients operated with the Bentall technique not including a Cabrol shunt.


CONCLUSIONS
Long-term results are satisfactory. In acute aortic dissection survival is decreased and late reoperations more frequent. The open technique is safe in non-dissection and in acute dissection and avoids pseudoaneurysm formation. The Bentall technique combined with Cabrol shunt is indicated if there is a high risk of hemorrhage. Long-term monitoring of the aorta is mandatory in patients with acute dissection and/or Marfan disease.
Niederhäuser
U
U
Department of Cardiovascular Surgery, University Hospital Zürich, Switzerland.
Künzli
A
A
Genoni
M
M
Vogt
P
P
Lachat
M
M
Turina
M
M
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000601:surgery*; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome