Comparison of three different surgical methods in aortic root aneurysms: long-term results.
BACKGROUND
Degenerative ascending aortic aneurysms frequently present with aortic valve pathology. If only the noncoronary sinus of Valsalva is dilated, replacement of the noncoronary sinus by tailoring the supracoronary graft with or without aortic valve replacement (AVR) can be a simple operation strategy. We sought to describe our experiences in this kind of operation, and compare them with a relatively homogeneous group of patients who underwent the classical Bentall operation.


METHODS
Between January 1997 and June 2007, 99 patients who had dilated ascending aortas with root dilatation and aortic valve pathology underwent operation. Patients were divided into three groups according to the surgical procedure. Classical Bentall operation was applied in 54 patients with dilated sinuses (Group 1). The other patients with dilated noncoronary sinus underwent either ascending aortic replacement with noncoronary sinus replacement (NSR, n = 27) (Group 2), or separate AVR and ascending aortic replacement with NSR (AVR + NSR, n = 18) (Group 3).


RESULTS
There were significant reduction of aortic root in Group 2 (Z =-4.560, p < 0.001), and Group 3 (Z =-3.758, p < 0.001). Degree of aortic regurgitation was decreased from 1.56 +/- 0.5 to 0.67 +/- 0.5 postoperatively in Group 2 (Z =-3.874, p < 0.001). Hospital mortality was six (6.1%) (three in Group 1; three in Group 2). Late mortality rate was 6.1% (three in Group 1, three in Group 2). The type of operation was not found to be an independent predictor of overall mortality. No patients in the NSR and AVR-NSR groups had aortic root aneurysm, and there were no reoperations or verified deaths caused by aortic root aneurysm in these patients.


CONCLUSIONS
Noncoronary cusp replacement for aortic root remodeling in patients with ascending aortic aneurysm is a technically simple and durable operation. Short- and mid-term results of this method were favorable compared to the Bentall procedure.
Caynak
Baris
B
Department of Cardiovascular Surgery, Istanbul Bilim University, Florence Nightingale Hospital, Istanbul, Turkey. caynakbaris@hotmail.com
Sagbas
Ertan
E
Onan
Burak
B
Onan
Ismihan Selen
IS
Sen
Onur
O
Bayramoglu
Zehra
Z
Kabakci
Birol
B
Sanisoglu
Ilhan
I
Akpinar
Belhhan
B
D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011474:Prosthesis Design; D012850:Sinus of Valsalva / Q000601:surgery*; D015996:Survival Rate; D036542:Tomography, Spiral Computed