Composite Valve Graft Replacement of the Aortic Root.
- Author:
Man Jong BAEK
1
;
Chan Young NA
;
Woong Han KIM
;
Sam Se OH
;
Soo Cheol KIM
;
Cheong LIM
;
Jae Wook RYU
;
Joon Hyuk KONG
;
Young Tak LEE
;
Wook Sung KIM
;
Hyun Soo MOON
;
Young Kwan PARK
;
Chong Whan KIM
Author Information
1. Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Sejong Heart Institute, Korea.
- Publication Type:Original Article
- Keywords:
Aortic root;
Graft
- MeSH:
Aneurysm;
Aorta;
Aorta, Thoracic;
Aortic Rupture;
Aortic Valve;
Aortic Valve Insufficiency;
Aortitis;
Bicuspid;
Cerebral Hemorrhage, Traumatic;
Coronary Artery Bypass;
Follow-Up Studies;
Freedom;
Hemorrhage;
Humans;
Marfan Syndrome;
Mitral Valve;
Mortality;
Pericardial Effusion;
Postoperative Complications;
Reoperation;
Retrospective Studies;
Shock, Cardiogenic;
Survivors;
Thoracic Surgery;
Transplants*;
Ventricular Dysfunction, Left
- From:The Korean Journal of Thoracic and Cardiovascular Surgery
2002;35(2):102-112
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: This study was undertaken to analyze the outcome of composite valve graft replacement(CVGR) for the treatment of aneurysms of the ascending aorta involving the aortic root. MATERIAL AND METHOD: Between April 1995 and June 2001, 56 patients had replacement of the ascending aorta and aortic root with a composite graft valve and were reviewed retrospectively. Aortic regurgitation was present in 50 patients(89%), Marfan's syndrome in 18 patients(32%), and bicuspid aortic valve in 7(12.5%). The indications for operation were annuloaortic ectasia(AAE) in 30 patients(53.6%), aortic dissection in 13(23.2%), aneurysms of the ascending aorta involving aortic root in 11(19.6%), and aortitis in 2(3.6%). Cardiogenic shock due to the aortic rupture was present in 2 patients. Nine patients(16%) had previous operations on the ascending aorta or open heart surgery. The operative techniques used for CVGR were the aortic button technique in 51 patients(91%), the modified Cabrol technique in 4, and the classic Bentall technique in 1. The concomitant procedures were aortic arch replacement in 24 patients(43%), coronary artery bypass graft in 8(14.3%), mitral valve repair in 2, redo mitral valve replacement in 1, and the others in 7. The mean time of circulatory arrest, total bypass, and aortic crossclamp were 21+/-14 minutes, 186+/-68 minutes, and 132+/-42 minutes, respectively. RESULT: Early mortality was 1.8%(1/56). The postoperative complications were left ventricular dysfunction in 16 patients(28.6%), reoperation for bleeding in 7(12.5%), pericardial effusion in 2, and the others in 7. Fifty-three patients out of 55 hospital survivors were followed up for a mean of 23.2+/-18.7 months(1-75 months). There were two late deaths(3.8%) including one death due to the traumatic cerebral hemorrhage, and CVGR-related late mortality was 1.9%. The 1- and 6-year actuarial survival was 98.1+/-1.9% and 93.2+/-5.1%, respectively. Two patients required reoperation for complication of CVGR(3.8%) and two other patients required subsequent operations for dissection of the remaining thoracoabdominal aorta. The 1- and 6-year actuarial freedom from reoperation was 97.8+/-2.0% and 65.3+/-26.7%, respectively. CONCLUSION: This study suggests that aortic root replacement with a composite valve graft for a variety of aneurysms of the ascending aorta involving the aortic root is a safe and effective therapy, with good early and intermediate results. Careful follow-up of all patients following composite graft root replacement is important to long-term survival.
