J Thorac Cardiovasc Surg 2005;129:236-237
© 2005 The American Association for Thoracic Surgery
Separate or composite graft replacement for diseases of both the aortic valve and the ascending aorta
Yoshio Misawa, MD,
Shin-ichi Ohki, MD,
Yasuhito Sakano, MD
Division of Cardiovascular Surgery, Jichi Medical School, 3311-1 Yakushiji, Minami-kawachi, Tochigi, 329-0498, Japan
To the Editor:
With great interest, we read an excellent article entitled "Clinical outcomes after separate and composite replacement of the aortic valve and ascending aorta," in the August 2004 issue of the Journal.1 Sioris and associates reported the differences between aortic root replacement and aortic valve replacement combined with supracoronary replacement of the ascending aorta (separate grafting). They concluded that separate grafting and the Bentall operation provide comparable long-term results and that no patient required reoperation for aortic root aneurysm after separate grafting in patients with aortic valve disease associated with normal or mildly dilated aortic sinuses or a dilated ascending aorta. Their study consisted of a large number of patients (587 patients), and their mean follow-up was 4.6 ± 3.1 years.
We have a patient who required aortic root replacement because of dilatation of the residual sinuses of Valsalva 10 years after separate grafting.2 The patient had undergone the initial operation for type A acute aortic dissection with severe aortic regurgitation. Retrospectively, our patient showed no dilatation of the sinuses of Valsalva until 4 years after the operation. The study by Sioris and associates1 included some patients with aortic dissection or aortic annulus ectasia. And no patient required reoperation for aortic root aneurysm after separate grafting in their follow-ups. As they mentioned, separate grafting might be a perfectly acceptable option for patients with aortic valve disease and a dilated ascending aorta. However, we believe a careful follow-up is imperative for patients undergoing separate grafting because of the possible risk involving dilation of the sinuses of Valsalva, particularly in patients with evidence of gross annuloaortic ectasia or cystic medionecrosis of the aortic wall. Therefore we are looking forward to an additional long-term report by Sioris and associates.1
References
- Sioris T, David TE, Ivanov J, Armstrong S, Feindel CM. Clinical outcomes after separate and composite replacement of the aortic valve and ascending aorta. J Thorac Cardiovasc Surg 2004;128:260-265.[Abstract/Free Full Text]
- Sano T, Konishi H, Ohki S, Saitoh T, Kamisawa O, Katoh M, et al. Sinus of Valsalva dilatation after replacement of the ascending aorta and aortic valve. Kyobu Geka 2003;56:786-789.[Medline]
