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The Journal of Thoracic and Cardiovascular Surgery, Vol 79, 388-401, Copyright © 1980 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
DC Miller, EB Stinson, PE Oyer, RJ Moreno-Cabral, BA Reitz, SJ Rossiter and NE Shumway
We reviewed a consecutive series of 90 patients undergoing concomitant
resection of ascending aortic anerysm and aortic valve replacement (AVR)
utilizing noncomposite "conventional" techniques in order to assess the
early and late results, to define limitations of this operative approach,
and thereby to clarify the indications for composite reconstruction of the
aortic root. Mean age was 55 years. Twenty percent had Marfan's syndrome,
and 13% had aortic dissections. The cause of the aneurysm was dissection in
13% of cases, syphilis in 11%, atherosclerosis in 9%, and degeneration
(with or without cystic medionecrosis) in 67%. Follow-up averaged 3.8 years
and extended to 11.5 years maximum. AVR and complete excision of the
aneurysm (preserving small tongues of aortic wall circumscribing the
coronary artery ostia) coupled with tubular graft replacement of the
ascending aorta were performed. Nineteen percent of patients required
individual technical modifications relating to the coronary arteries.
Operative mortality rate was 13%, with the majority of deaths being due to
cardiac causes. Contemporary (1975 to 1978) operative mortality rate was
4.3%. Seven percent required re-exploration for hemorrhage and 2.4% had
perioperative myocardial infarctions. Late functional results were
generally good (average N.Y.H.A. Class 1.4). Late thromboembolism, angina,
myocardial infarction, and congestive heart failure occurred at linearized
rates of 3.4% per patient-year, 4.9% per patient-year, 1.1% per
patient-year, and 5.2% per patient-year, respectively. No prosthetic valve
endocarditis, graft infection, or recurrent aneurysms of the aortic root
were observed. Late reoperation was necessary in eight patients (3% per
patient-year), but reoperation for disease confined to the ascending aorta
accounted for only three of these cases (1.1% per patient-year). Overall
actuarial survival rates were 67% +/- 5% at 5 years and 50% +/- 9% at 10
years; survival rates for the 78 operative survivors were 77% +/- 5% and
57% +/- 10% at the same time intervals, respectively. Only one late death
could be attributed to complications arising in the reconstructed aortic
root. These results confirm that such simple, noncomposite techniques are
safe, portend minimal risk of late complications and the attendant
necessity for reoperation, and provide satisfactory long-term survival. We
believe that composite techniques should be primarily reserved for selected
cases of advanced necrotizing prosthetic or natural endocarditis.
ARTICLES
Concomitant resection of ascending aortic aneurysm and replacement of the aortic valve: operative and long-term results with "conventional" techniques in ninety patients
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