title: Five-year experience in aortic root replacement with the flanged composite graft.
abstract: BACKGROUND
  Replacement of the aortic root with a composite graft containing a prosthetic mechanic valve is the preferred surgical procedure for tailoring the aortic root. The aim of this study is to determine the 5-year experience with the composite root replacement using our new modification of the Bentall technique.
  
  
  METHODS
  Between January 1996 and June 2001, 96 patients underwent aortic root replacement using a flanged composite graft. Eighty patients (83.3%) were male, and 16 patients (16.7%) were female with a mean age of 48.7 +/- 14.4 years. Indications for operation were a true or false aneurysm (65.6%), severe calcified aortic valve stenosis (4.2%) or severe aortic insufficiency (2.1%) with dilated ascending aorta, acute dissection (2.1%), or combination of indications (26%). Thirty-one patients (32.3%) received a concomitant cardiac procedure. Mean aortic cross-clamp time was 89.5 +/- 28.6 minutes, and mean cardiopulmonary bypass time was 146.2 +/- 45.6 minutes. Total follow-up was 253.9 patient-years.
  
  
  RESULTS
  Operative mortality was 8.3% (8 patients). The causes of hospital mortality were severe bleeding (3 patients), low cardiac output syndrome (2), acute respiratory distress syndrome (2) and cerebrovascular event (1). No patient died of flange-related complications. Univariate predictors of early mortality were low cardiac output syndrome (p < 0.001), neurologic complication (p = 0.03), and renal complication (p = 0.03). Multivariate analysis demonstrated only low cardiac output syndrome to be significant (p = 0.001) predictor for early mortality. There were five (5.7%) late deaths. Actuarial survival was 82.65% +/- 4.8% at 5 years (1.95% patient-year). Cox proportional hazards regression analysis demonstrated only low cardiac output syndrome to be significant (p = 0.032) predictor for late mortality. Actuarial freedom from prosthetic- and technique-related mortality was 100% at 5 years.
  
  
  CONCLUSIONS
  The flanged composite graft offers excellent long-term results, with very low prevalence of prosthetic-related complications. The new created sinuses and the flange are especially helpful to continue physiologic function of the aortic root.
authors: Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey. imkkirali@yahoo.com
authors: Kaan
authors: K
authors: Kirali
authors: Denyan
authors: D
authors: Mansuroğlu
authors: Suat Nail
authors: SN
authors: Omeroğlu
authors: Vedat
authors: V
authors: Erentuğ
authors: Ilker
authors: I
authors: Mataraci
authors: Gökhan
authors: G
authors: Ipek
authors: Esat
authors: E
authors: Alcinci
authors: Omer
authors: O
authors: Işik
authors: Cevat
authors: C
authors: Yakut
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality; D011474:Prosthesis Design