Surgery for aneurysms of the aortic root: a 30-year experience.
BACKGROUND
This study evaluated long-term results of aortic root replacement and valve-preserving aortic root reconstruction for patients with aneurysms involving the aortic root.


RESULTS
Two-hundred three patients aged 53+/-16 years (mean+/-SD; 153 male, 50 female) underwent elective or urgent aortic root surgery from 1971 to 2000 for an aortic root aneurysm: 149 patients underwent a composite valve conduit reconstruction, and 54 patients underwent valve-preserving aortic root reconstruction. Fifty patients had Marfan syndrome. In-hospital and 30-day mortality was 4.0% (8/203) overall: for a composite valve conduit procedure, the corresponding value was 4.0% (6/149) and for valve-preserving procedure, 3.7% (2/54) (P=NS). Morbidity included 3 strokes (1%), 10 perioperative myocardial infarctions (5%), and 8 reoperations for bleeding (4%). Actuarial survival at 5, 10, 15, and 20 years was 93% (95% confidence interval [CI] = 88% to 97%), 79% (95% CI = 71% to 87%), 67% (95% CI = 57% to 79%), and 52% (95% CI = 36% to 69%), respectively. Freedom from reoperation was 72% (95% CI = 54% to 86%) at 20 years. Complications with anticoagulation occurred in 29 patients; with valve thrombosis, in 2; and with hemorrhage, in 27 (4 life threatening and 23 minor). Freedom from thromboembolism was 91% (95% CI = 77% to 98%) at 20 years. Freedom from endocarditis was 99% (95% CI = 92% to 100%) at 20 years. Multivariate analysis revealed preoperative mitral valve regurgitation (+3 to 4) and older age to be significant predictors of late death (P< or =0.005), and Marfan syndrome, initial valve-preserving aortic root reconstruction, and need for a concomitant procedure at initial operation to be significant predictors of the need for reoperation (P< or =0.01).


CONCLUSIONS
Aortic root replacement for aortic root aneurysms can be done with low morbidity and mortality. Composite valve conduit reconstruction resulted in a durable result. There were few serious complications related to the need for long-term anticoagulation or a prosthetic valve. Reoperation was most commonly required because of failure of the aortic valve when a valve-preserving aortic root reconstruction was performed or for other cardiac or aortic disease elsewhere.
Zehr
Kenton J
KJ
Division of Cardiovascular Surgery, Mayo Clinic, 200 First St SW, Rochester, Minn 55905, USA. zehr.kenton@mayo.edu
Orszulak
Thomas A
TA
Mullany
Charles J
CJ
Matloobi
Alireza
A
Daly
Richard C
RC
Dearani
Joseph A
JA
Sundt
Thoralf M
TM
Puga
Francisco J
FJ
Danielson
Gordon K
GK
Schaff
Hartzell V
HV
D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000209:etiology / Q000601:surgery*; D018572:Disease-Free Survival; D004696:Endocarditis / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D015993:Life Tables; D008297:Male; D008382:Marfan Syndrome / Q000150:complications; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications; D009203:Myocardial Infarction / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012850:Sinus of Valsalva / Q000601:surgery*; D020521:Stroke / Q000453:epidemiology; D016019:Survival Analysis; D015996:Survival Rate; D013923:Thromboembolism / Q000453:epidemiology
D000925:Anticoagulants