title: Analysis of aortic root surgery with composite mechanical aortic valve conduit and valve-sparing reconstruction.
abstract: OBJECTIVE
  Comparative analysis of early and late results of aortic root reconstruction with aortic valve sparing operations and the composite mechanical valve conduit replacement.
  
  
  METHODS
  From November 2002 to September 2009, 164 consecutive patients with mean age 54 ± 15 years, 115 male, underwent the aortic root reconstruction (125 mechanical valve conduit replacements and 39 valve sparing operations). Sixteen percent of patients had Marfan syndrome and 4.3% had bicuspid aortic valve. One hundred and forty-four patients (88%) were followed for a mean period of 41.1 ± 20.8 months.
  
  
  RESULTS
  The hospital mortality was 4.9%, 5.6% in operations with valved conduits and 2.6% in the valve sparing procedures (P <0.05). There was no difference neither in survival (95% CI = 86% - 96%, P= 0.1) nor in reoperation-free survival (95% CI = 85% - 90%, P = 0.29). The survival free of complications such as bleeding, thromboembolism and endocarditis were favorable to the valve sparing operations, respectively (95% CI = 70% - 95%, P = 0.001), (95% CI = 82% - 95% P = 0.03) and (95% CI = 81% - 95%, P = 0.03). Multivariate analysis showed that creatinine greater than 1.4 mg/dl, Cabrol operation and renal dialysis were predictors of mortality, respectively, with occurrence chance of 6 (95% CI = 1.8 - 19.5, P = 0.003), 12 (95% CI = 3 - 49.7, P = 0.0004) and 16 (95% CI = 3.6 - 71.3, P = 0.0002).
  
  
  CONCLUSIONS
  The aortic root reconstruction has a low early and late mortality, high survival free of complications and low need for reoperation. During the late follow-up, valve sparing aortic root reconstructions presented fewer incidences of bleeding, thromboembolic events and endocarditis.
authors.affiliation: UnidadeCirúrgica de Cardiopatias Gerais, USP, São Paulo, Brasil. ricardo.dias@incor.usp.br
authors.forename: Ricardo Ribeiro
authors.initials: RR
authors.lastname: Dias
authors.forename: Omar Asdrubal Vilca
authors.initials: OA
authors.lastname: Mejia
authors.forename: Alfredo Inácio
authors.initials: AI
authors.lastname: Fiorelli
authors.forename: Pablo Maria Alberto
authors.initials: PM
authors.lastname: Pomerantzeff
authors.forename: Altamiro Ribeiro
authors.initials: AR
authors.lastname: Dias
authors.forename: Charles
authors.initials: C
authors.lastname: Mady
authors.forename: Noedir Antonio Groppo
authors.initials: NA
authors.lastname: Stolf
mesh_terms: D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities / Q000601:surgery*; D004812:Epidemiologic Methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000150:complications; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome