Aortic root replacement: comparison of clinical outcome between different surgical techniques.
OBJECTIVE
To examine the influence of different surgical procedures on clinical outcome in patients undergoing aortic root replacement for ascending aorta aneurysm (AAA) with or without concomitant aortic valve regurgitation (AR).


METHODS
Between 2000 and 2011, a total of 370 patients (mean age 52 ± 17 years) underwent aortic root replacement. Patients were retrospectively assigned to three groups according to the surgical procedures: valve-sparing root replacement (VSRR) (Group A; n = 178), Bentall procedure with a biological conduit (Group B; n = 91) and with a mechanical conduit (Group C; n = 101). All patients were studied with clinical assessment and echocardiography during a mean follow-up time of 4.3 years.


RESULTS
Estimated 5-year survival probability rates for Groups A, B and C were 95.2 ± 1.8, 80.9 ± 4.4 and 79.3 ± 4.5%, respectively (P < 0.01; log-rank). Estimated 5-year survival probability rates for patients who had undergone elective operations for Groups A, B and C were 96.1 ± 1.8, 88.9 ± 4.4 and 82.3 ± 4.9%, respectively (P = 0.02; log-rank). Actuarial overall 5-year freedom from valve-related reoperations was 94.3 ± 1.9%, without being significantly different between groups (P = 0.13; log-rank). Estimated 5-year probability rates for freedom from major bleeding events for Groups A, B and C were 99.3 ± 0.7, 100 and 93.0 ± 3.4%, respectively (P = 0.03; log-rank). Actuarial overall 5-year freedom from thromboembolism and endocarditis were 93.6 ± 0.2% (P = 0.53; log-rank) and 96.1 ± 1.5% (P = 0.46; log-rank), respectively, without significant differences between groups.


CONCLUSIONS
The data from the present study support the VSRR strategy in patients undergoing aortic root replacement. Furthermore, if Bentall operation is unavoidable, biological valved conduit should be preferred in order to avoid late bleeding complications.
Department of Cardiovascular Surgery, German Heart Centre Munich, Clinic at the Technical University Munich, Munich, Germany badiu@dhm.mhn.de.
Catalin Constantin
CC
Badiu
Department of Cardiovascular Surgery, German Heart Centre Munich, Clinic at the Technical University Munich, Munich, Germany.
Marcus André
MA
Deutsch
Department of Cardiovascular Surgery, German Heart Centre Munich, Clinic at the Technical University Munich, Munich, Germany.
Constantinos
C
Sideris
Department of Cardiovascular Surgery, German Heart Centre Munich, Clinic at the Technical University Munich, Munich, Germany.
Markus
M
Krane
Department of Cardiovascular Surgery, German Heart Centre Munich, Clinic at the Technical University Munich, Munich, Germany.
Ina
I
Hettich
Department of Cardiovascular Surgery, German Heart Centre Munich, Clinic at the Technical University Munich, Munich, Germany.
Bernhard
B
Voss
Department of Cardiovascular Surgery, German Heart Centre Munich, Clinic at the Technical University Munich, Munich, Germany.
Domenico
D
Mazzitelli
Department of Cardiovascular Surgery, German Heart Centre Munich, Clinic at the Technical University Munich, Munich, Germany.
Rüdiger
R
Lange
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
Aorta; Aortic valve; Valve lesions