title: Aortic root replacement for ascending aortic disease: a 10 year review.
abstract: BACKGROUND
  Bentall's procedure and its modifications have been used for over 40 years for the treatment of ascending aortic disease. This study reviewed 10 years of experience with Aortic Root Replacement (ARR) in a major cardiac surgical centre.
  
  
  METHODS
  Eighty-nine patients underwent ARR between 1999 and 2009. The records were scrutinised by retrospective chart review.
  
  
  RESULTS
  The mean age was 54 years. Seventy-nine percent of patients were male and 21% female. The indications for the procedure were Aortic Root Aneurysm (ARA) (65%), type A dissection (28%), infective endocarditis (4.4%) and prosthetic valve regurgitation (2.2%). Fifty-seven percent of these were performed electively and 43% as an emergency. A bicuspid aortic valve was present in 37%. Arch surgery was required in 15.7%, bypass grafting in 12.3% and mitral valve surgery in 5.6%. The descending aorta was involved in 16.8%. Operative mortality was 3.3% and in-hospital mortality 12.3%. Mean follow-up was 67.05 months (range 2-143). No patients required re-operation.
  
  
  CONCLUSIONS
  The factors associated with increased in-hospital mortality were pre-operative haemodynamic instability, concommitant coronary artery disease and acute renal failure. The presence of a bicuspid valve may be associated with lower rates of complications, but no difference in mortality.
authors.affiliation: Department of Cardiothoracic Surgery, Royal Perth Hospital, Western Australia, Australia. Electronic address: bdunne14784@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Dunne
authors.affiliation: Department of Cardiothoracic Surgery, Royal Perth Hospital, Western Australia, Australia.
authors.forename: T
authors.initials: T
authors.lastname: Marr
authors.affiliation: Department of Cardiothoracic Surgery, Royal Perth Hospital, Western Australia, Australia.
authors.forename: D
authors.initials: D
authors.lastname: Andrews
authors.affiliation: Department of Cardiothoracic Surgery, Royal Perth Hospital, Western Australia, Australia.
authors.forename: R
authors.initials: R
authors.lastname: Larbalestier
authors.affiliation: Department of Cardiothoracic Surgery, Royal Perth Hospital, Western Australia, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Edwards
authors.affiliation: Department of Cardiothoracic Surgery, Royal Perth Hospital, Western Australia, Australia.
authors.forename: C
authors.initials: C
authors.lastname: Merry
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000503:physiopathology / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery; D001014:Aortic Aneurysm / Q000503:physiopathology / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D001281:Atrial Fibrillation / Q000209:etiology; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000150:complications / Q000601:surgery; D017558:Elective Surgical Procedures; D004630:Emergencies; D004696:Endocarditis / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult