SURGERY OF ANEURYSMS OF THE ASCENDING AOR TA - RESULTS IN 203 PATIENTS

From April 73 to June 94, 203 patients (167 men, 36 women) aged from 1 0 to 74 years (mean 44.8 +/- 15) underwent ascending aortic replacemen t with a composite graft for : dystrophic aneurysm (AN) (130 cases, 64 .5 %), chronic dissection (CD) (35 cases, 17.2 %), type A acute dissec tion (AD) (38 cases, 19 %). Forty six patients (22.6 %) suffered from Marfan syndrome (24 AN, 13 AD, 9 CD). Thirty patients (14.7 %) had und ergone a previous cardiac or aortic operation. The ascending aortic re placement was extended to the transverse arch in 28 patients (14 %). A mechanical valve was used in 193 cases (95 %). The technique of coron ary reattachment has varied with time and according to the aortic lesi ons. The classic ''Bentall'' technique was used in 87 patients (43 %), the ''button'' technique in 74 (36 %), the ''Cabrol'' technique in 26 (13 %) and a ''mixed'' technique in 16 cases (8 %). The hospital mort ality rate was 7.3 % (15/203) (AN : 2.3 %, CD : 11.4 %, AD : 21 %). Th e only predictors of hospital death were emergency AD (p < 0.03) and a rch replacement (p < 0.02). Mean follow-up was 46 +/- 10 months (2-246 ), The overall long-term survival rate was (Kaplan Meier) 89 +/- 6 % a t 1 year, 77.9 % at 5 years, 67.7 +/- 12 % at 10 years and 61.3 % +/- 15 % at 12 years, The 10 years survival rate is significantly higher i n patients with AN (77.8 +/- 11 %) than in those with AD (61.6 +/- 17 %) (Log rank: p < 0.01). The late survival rate is also significantly higher after the ''button'' or Bentall reimplantation that after the ' 'Cabrol'' or ''mixed'' methods (90 +/- 5 % in the ''button'' group and 88.7 +/- 6 %, 83.8 +/- 9 % and 76.6 +/- 12 % in the ''Bentall'' group vs 80 +/- 18 %, 63 +/- 21 % and 58 +/- 35 % in the ''Cabrol'' group a t 1, 5 and 8 years, respectively). ln conclusion, ascending aortic rep lacement with a composite graft is a safe procedure especially when pe rformed electively in patients with dystrophic aneurysm or Marfan synd rome. The technique of coronary reimplantation has a significant on th e long-term results.