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The Journal of Thoracic and Cardiovascular Surgery, Vol 93, 375-384, Copyright © 1987 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
RK Jex, HV Schaff, JM Piehler, TA Orszulak, FJ Puga, RM King, GK Danielson and JR Pluth
Operative treatment of dissections of the ascending aorta differs from that
for the descending aorta, not only because of the need for cardiopulmonary
bypass, but also because of the frequent occurrence of aortic valve
insufficiency. To determine the early and late results of operative repair,
we have reviewed the case histories of 121 consecutive patients who
underwent repair of ascending aortic dissections between 1962 and 1985.
Ages ranged from 16 to 79 years (mean 56 +/- 14 years); 54 patients had
operation within 2 weeks of onset of symptoms (acute), and the remainder
had later repair (chronic). Seventy patients (58%) had clinical evidence of
aortic insufficiency at the time of admission. During repair of acute
dissection, 10 patients (19%) had aortic valve resuspension and 15 patients
(28%) had aortic valve replacement. During repair of chronic dissection,
eight patients (12%) had resuspension and 43 patients (64%) had
replacement. Overall operative mortality was 22%, significantly higher for
patients with acute than for those with chronic dissections (39% versus 9%,
p less than 0.01). Operative risk was similar for patients who underwent
repair of ascending aortic dissections without valve resuspension or
replacement (31%) versus those who had repair with aortic valve
resuspension (17%) or replacement (17%). During a follow-up period ranging
from 1 to 208 months, aortic regurgitation developed in only two patients
who did not have aortic insufficiency at the time of repair. Late aortic
regurgitation necessitating reoperation developed in one of the 15
survivors who had aortic valve resuspension. Eight patients undergoing
aortic valve replacement had complications of their prostheses, including
one periprosthetic leak and four mechanical failures. We conclude that
resuspension or replacement of the aortic valve does not increase the risk
of repair of ascending aortic dissections. Selective management of aortic
insufficiency (with valve repair whenever possible) yields satisfactory
long-term results.
ARTICLES
Repair of ascending aortic dissection. Influence of associated aortic valve insufficiency on early and late results
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