title: Aortic root replacement with coronary button re-implantation: low risk and predictable outcome.
abstract: OBJECTIVE
  Cardiac morbidity in aortic root replacement often occurs through myocardial ischaemia. We analyzed a 10 year experience of all root replacement operations by one surgeon to determine the incidence of coronary complications and risk factors for early mortality.
  
  
  METHODS
  The study included 140 aortic root replacement patients (aged from 2 to 77 years; median 53 years) operated between 1988 and 1999. Thirty-four had Marfan's syndrome. Eleven had root infection requiring homograft replacement. Nineteen were reoperations (14%). Concomitant procedures were arch replacement (16), mitral replacement (five), and coronary bypass (22). Mobilization and reimplantation of the coronary ostia was performed in 139 patients. We performed the distal graft anastomosis before right coronary reimplantation.
  
  
  RESULTS
  There were eight hospital deaths (5.7%). Risk factors for hospital mortality were: preoperative NYHA class IV, shock, LVEF < or =30%, acute dissection, concomitant mitral valve replacement, pump time > or = 60 min, reentry for bleeding, and postoperative renal failure. Neither myocardial ischaemia nor right ventricular dysfunction contribute to mortality. There were 18 late deaths with an actuarial survival of 79% at 5 years. There were no late coronary false aneurysms.
  
  
  CONCLUSIONS
  Button reimplantation with the sequence described is predictable and safe. Wrap-around is unnecessary. Coronary aneurysms have been eliminated.
authors.affiliation: Oxford Heart Centre, John Radcliffe Hospital, Headley Way, Headington, Oxford, UK. swestaby@AHF.org.uk
authors.forename: S
authors.initials: S
authors.lastname: Westaby
authors.forename: T
authors.initials: T
authors.lastname: Katsumata
authors.forename: G
authors.initials: G
authors.lastname: Vaccari
mesh_terms: D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery; D001018:Aortic Diseases / Q000601:surgery*; D001161:Arteriosclerosis / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation; D002648:Child; D002675:Child, Preschool; D003331:Coronary Vessels / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged