Aortic root replacement with a composite graft: Results of 69 operations in 66 patients

Abstract

Between December 1973 and December 1992, 66 patients underwent aortic root replacement at our hospital. The mean age of the patients was 42.5 years (range, 20 to 71 years); 44 patients were male and 22 were female. Of the 66 patients, 34 (51.5%) had clinical stigmata of Marfan's syndrome. The aortic pathology requiring aortic root replacement was annuloaortic ectasia in 59 patients, aortic dissection in 5, and progressive dilatation of the ascending aorta after aortic valve replacement in 2. Twelve of the 59 patients with annuloaortic ectasia also had aortic dissection. The operative techniques used were the Bentall technique in 36 operations, the Cabrol technique in 21, the aortic button technique in 3, and other miscellaneous techniques in 9. The hospital mortality rate for the primary operation was 10.6% (7 patients), and the late mortality rate was 20.3% (12 patients). Four of the late deaths were related to the graft valve prosthesis, and 6 were related to the progression of aneurysmal diseases on the remaining aorta. The survival rate was 71.0% at 10 years. Pseudoaneurysm at the suture lines was detected in 7 patients, 6 of whom had been treated with the Bentall technique, and 5 patients also had Marfan's syndrome. No patients having aortic root replacement with the Cabrol technique have required reoperation for pseudoaneurysms. Two patients had valve thrombosis, and 2 other patients had prosthetic endocarditis. An operation was performed on the remaining aortic segment in 5 patients and 3 survived. Four patients who were not operated on died of rupture of aneurysmal diseases. These results suggest that the keys to successful aortic root replacement may be the achievement of perfect hemostasis and the elimination of tension on the anastomoses, and that these may be accomplished best by using open techniques and coronary artery reattachment with separate tube grafts, as in the Cabrol and the separate interposition graft techniques or in the aortic button technique. A more extensive aortic replacement may be required to improve long-term results in patients undergoing aortic root replacement.