Composite valve graft replacement of the aortic root: twenty-seven years of experience at one Japanese center.
BACKGROUND
The aim of this study was to evaluate the early and long-term results of a composite valve graft root replacement for various aortic root diseases.


METHODS
Between 1978 and 2005, 273 patients with various disorders of the aortic root underwent a composite valve graft root replacement. The mean age of the patients was 47.5 +/- 13.2 years. There were 93 patients with Marfan syndrome, 56 aortitis, and 63 type A aortic dissections. Thirty-nine emergency operations and 55 redo operations were included. For the proximal anastomosis, a skirted technique was used in 157 patients. For the coronary reconstruction, Bentall's original inclusion technique was utilized in 36 patients, a direct button technique in 159, and a graft interposition technique in 63. The mean follow-up was 106 months.


RESULTS
The in-hospital mortality was 9.5%. An emergency operation emerged as a significant predictor of early death. The actuarial survival rate was 87.0% and 72.9% at 5 and 15 years, respectively. The age at the operation, aortitis, Marfan syndrome, and use of a standard proximal anastomosis emerged as independent determinants of late death. The actuarial reoperation free rate was 96.3% and 89.7% at 5 and 15 years, respectively. In the patients who underwent the skirted technique the incidence of late graft detachment was less frequent than that of the standard technique.


CONCLUSIONS
A composite valve graft root replacement is a safe and reliable procedure for various aortic root diseases with stable early- and long-term results. The skirted technique seems to be attractive to avoid late graft detachment even in cases with a fragile inflammatory pathology.
Tsunekawa
Tomohiro
T
Department of Cardiothoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Ogino
Hitoshi
H
Matsuda
Hitoshi
H
Minatoya
Kenji
K
Sasaki
Hiroaki
H
Kobayashi
Junjiro
J
Yagihara
Toshikatsu
T
Kitamura
Soichiro
S
D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D000925:Anticoagulants / Q000009:adverse effects; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D001025:Aortitis / Q000601:surgery; D016001:Confidence Intervals; D018572:Disease-Free Survival; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D013530:Surgical Wound Infection / Q000209:etiology; D015996:Survival Rate; D013923:Thromboembolism / Q000209:etiology
D000925:Anticoagulants