REPLACEMENT OF THE ASCENDING AORTA WITH COMPOSITE VALVE GRAFTS - LONG-TERM RESULTS

Background and aims of the study: Long term survival after replacement of the aortic root is improving. The most common cause of late death is progression of disease in the remaining aorta (dissection or athero sclerosis). The purpose of this study was to review our clinical exper ience with composite graft replacement of the aortic root with special reference to long term results. Materials and methods: One hundred tw enty-six patients (mean age: 53 years) with different pathologies of t he ascending aorta underwent aortic root replacement with a composite- graft prosthesis over a 12-year period. Twenty-three patients had prev iously undergone cardiovascular surgery. The surgical technique includ ed resection of the ascending aorta with the aortic valve and end-to-s ide anastomosis between full-thickness buttons of the aortic wall with the coronary ostia and the graft. One or more associated cardiovascul ar procedures were performed in 24 cases. Long term follow up to July 1995 is complete. Uni- and multivariate analysis were performed to ide ntify risk-factors for early and late mortality and reoperation. Resul ts: Twenty-three patients died during the first 30 days (18%). Sixteen of them had aortic dissection. The most common cause of early death w as heart failure. Twenty-three patients died during, the follow up tim e with heart failure, again, being the most common cause of death. Thi rteen late reoperations on the composite-graft or the remaining aorta were performed in 12 patients, six of whom had Marfan's syndrome. The 30-day mortality at reoperation was 30%. Conclusions: This surgical op tion offers good long term results with a five-year actuarial survival of 67% or 75% when the 30-day mortality is excluded. Careful follow u p of patients with Marfan's syndrome and/or aortic dissection is manda tory to increase the long term survival.