title: Are thromboembolic and bleeding complications a drawback for composite aortic root replacement?
abstract: BACKGROUND
  Valve-preserving aortic root reconstruction is being performed with increasing frequency. Independent of durability concerns, enthusiasm for retaining the native valve is often championed on the presumption that composite graft replacement of the aorta will be complicated by thromboembolism and bleeding. Our goal in this late follow-up study is to determine if thromboembolism or bleeding, or both, are indeed problematic after composite aortic root replacement.
  
  
  METHODS
  Between 1995 and 2011, 306 patients (mean age, 56±14 years) underwent composite graft replacement of the aorta. St. Jude mechanical valve conduits (St. Jude Medical, St Paul, MN) were used in 242 patients, and 64 received a biologic conduit. Long-term postoperative follow-up (mean, 56 months; range, 1 to 97 months) was performed through our Aortic Database, supplemented by patient interviews and use of the Social Security Death Index.
  
  
  RESULTS
  Hospital mortality was 2.9% overall and 1.4% in the last 8 years. Kaplan-Meier curves showed freedom (±standard deviation) from bleeding, stroke, and distal embolism as 94.3%±1.7% at 5 years and 91.3%±2.4% at 10 years. Survival was 93.5%±1.8% at 5 years and 80.9%±4.6% at 10 years, which was not statistically different from that for an age- and sex-matched population in Connecticut. Freedom from reoperation of the aortic root was 99% at 10 years.
  
  
  CONCLUSIONS
  Patients had excellent survival and few thromboembolic and bleeding complications after composite aortic root replacement. These data supporting minimal morbidity in the setting of well-established durability should be used to put alternative procedures, such as valve-preserving aortic root reconstruction, into context.
authors.affiliation: Section of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Zafar
authors.forename: Emily A
authors.initials: EA
authors.lastname: Farkas
authors.forename: Andrei
authors.initials: A
authors.lastname: Javier
authors.forename: Melody
authors.initials: M
authors.lastname: Anderson
authors.forename: Owais
authors.initials: O
authors.lastname: Gilani
authors.forename: John A
authors.initials: JA
authors.lastname: Elefteriades
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000379:methods; D015331:Cohort Studies; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000401:mortality*; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D017751:Safety Management; D016019:Survival Analysis; D013923:Thromboembolism / Q000209:etiology / Q000401:mortality*; D016896:Treatment Outcome; D014463:Ultrasonography