title: Long term outcomes of aortic root replacement: 18 years' experience.
abstract: BACKGROUND
  We reviewed the long-term outcomes of aortic root replacement at Asan Medical Center and investigated the predictors affecting mortality.
  
  
  METHODS
  A retrospective analysis was performed on 225 consecutive adult patients undergoing aortic root replacement with mechanical conduits (n=169), porcine aortic root prosthesis (n=23), or aortic homografts (n=33) from January 1992 to September 2009. The median follow-up duration was 6.1 years (range, 0 to 18.0 years).
  
  
  RESULTS
  The porcine root group was older than the other groups (freestyle 55.9±14.3 years vs. mechanical 46.3±14.6 years, homograft 48.1±14.7 years; p=0.02). The mechanical group had the highest incidence of the Marfan syndrome (mechanical 22%, freestyle 4%, homograft 3%; p=0.01). Surgery performed for infective endocarditis was more frequent in the homograft group (mechanical 10%, freestyle 10%, homograft 40%; p<0.001). The overall 30-day mortality was 5.3% (12/225). Actuarial survival rates in the mechanical, porcine root, and homograft groups were 79.4%, 81.5%, and 83.5% at 5 years and 67%, 61.9%, and 61.1% at 10 years, respectively (p=0.73). By multivariate analysis, preoperative diabetes mellitus, older age, and longer cardiopulmonary bypass time were independent predictors of mortality. Incidence of postoperative complications, including infective endocarditis and thromboembolism were comparable in all of the groups.
  
  
  CONCLUSIONS
  Aortic root replacement can be safely performed with different types of prostheses as the outcome was not affected by the choice of prosthesis. Further studies are required to assess the long-term durability of biological prostheses.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Korea.
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Bang
authors.forename: Yu-Mi
authors.initials: YM
authors.lastname: Im
authors.forename: Joon Bum
authors.initials: JB
authors.lastname: Kim
authors.forename: Suk Jung
authors.initials: SJ
authors.lastname: Choo
authors.forename: Cheol Hyun
authors.initials: CH
authors.lastname: Chung
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Lee
authors.forename: Sung-Ho
authors.initials: SH
authors.lastname: Jung
keywords: Aorta, surgery; Aortic valve, surgery; Follow-up studies; Heart valve prosthesis