Abstract 9678: Long Term Results of Aortic Valve and Root Replacement in 1045 Patients Over Thirty-Three Years. A Single-Centre Experience

Abstract

Introduction. Aortic root replacement using composite graft represents the treatment of choice for a large variety of aortic root diseases. The aim of the current study is to evaluate the long-term results of this procedure. Methods. Between 1978 and 2010, 1045 patients aged 58.7±13.6 years (834 males) underwent aortic root composite graft replacement: 95 (9.1%) underwent Bentall operation, 926 (88.6%) were operated following the “button technique”, whereas 24 (2.3%) underwent Cabrol technique. Six-hundred thirty five patients (62.3%) had annuloaortic ectasia and 162 (15.5%) aortic dissection. Results. Overall in-hospital mortality was 5.3% (55/1045). Independent risk factors for in-hospital mortality at logistic regression analysis were age (p=0.051,OR=3.2), preoperative NYHA class III-IV (p=0.015,OR=5.9), aortic dissection (p=0.059,OR=3.6) and Cabrol technique (p=0.065,OR=2.2). Overall actuarial survival at 5, 10, and 20 years was 84.1%±1.3%, 65.5%±2.6%, and 40.7%±4.6%, respectively. Multivariate analysis revealed preoperative EF<50% (p=0.057, OR=3.1), postoperative neurologic complications (p=0.013, OR=6.1) and postoperative pulmonary complications (p=0.046, OR=3.9) to be significant predictors of late death. Freedom from thromboembolism, freedom from bleeding complications, and freedom from endocarditis was 93.7%±2.6%, 90.3%±3.1%, and 98.4%±1% at 20 years, respectively. Freedom from aortic reoperation was 91.8%±2.1% at 20 years, and was significantly lower in patients with aortic dissection. Conclusions. Aortic root replacement for aortic root aneurysms can be performed with low morbidity and mortality and with satisfactory long-term results. Few late serious complications were related to the need for long-term anticoagulation or a prosthetic valve. Reoperation on the proximal or in the distal aorta was most commonly performed in patients with aortic dissection.