title: Replacement of the aortic root with a composite valve-graft conduit: risk factor analysis in 246 consecutive patients.
abstract: BACKGROUND
  Composite valve-graft (CVG) replacement of the aortic root is a well-studied and recognised treatment for various aortic root conditions, including valvular disease with associated aortopathy. There have been few previous studies of the procedure in large numbers in an Australian setting.
  
  
  METHODS
  From January 2006 to June 2013, 246 successive patients underwent CVG root replacements at our institution. Mean age was 56.8 years, 85.4% were male, and 87 had evidence of bicuspid aortic valve. Indications for operation included ascending aortic aneurysm in 222 patients, annuloaortic ectasia in 67 patients, and aortic dissection in 38 patients.
  
  
  RESULTS
  The overall unit 30-day mortality was 5.7%, including: elective 30-day mortality of 2.2%, and emergent 30-day mortality of 17.2%. Statistically significant multivariate predictors of 30-day mortality were: acute aortic dissection (OR=20.07), peripheral vascular disease (OR=11.17), new ventricular tachycardia (OR=30.17), re-operation for bleeding (OR=14.42), concomitant mitral stenosis (OR=68.30), and cerebrovascular accident (OR=144.85).
  
  
  CONCLUSIONS
  Low postoperative mortality in our series matches closely with results from similar sized international studies, demonstrating that this procedure can be performed with low risk in centres with sufficient experience in the operative procedure.
authors.affiliation: University of New South Wales Medical School, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia.
authors.forename: Kei
authors.initials: K
authors.lastname: Woldendorp
authors.affiliation: Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia.
authors.forename: Eric
authors.initials: E
authors.lastname: Starra
authors.affiliation: Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Seco
authors.affiliation: Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: P Nicholas
authors.initials: PN
authors.lastname: Hendel
authors.affiliation: Sydney Medical School, The University of Sydney, Sydney, Australia; Cardiology Department, Royal Prince Alfred Hospital, Sydney, Australia.
authors.forename: Richmond W
authors.initials: RW
authors.lastname: Jeremy
authors.affiliation: The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.
authors.forename: Michael K
authors.initials: MK
authors.lastname: Wilson
authors.affiliation: Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Vallely
authors.affiliation: Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart and Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia. Electronic address: pgbannon@gmail.com.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Bannon
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery; D001011:Aorta; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery; D001807:Blood Vessel Prosthesis; D018572:Disease-Free Survival; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate
keywords: Aortic root replacement; Aortic valve replacement; Bentall procedure; Bicuspid aortic valve; Composite valve graft