COMPOSITE GRAFT (MEDTRONIC-HALL) REPLACEMENT OF THE ASCENDING AORTA AND AORTIC-VALVE IN AORTIC-ANEURYSMS - WHAT IS ADEQUATE FOLLOW-UP

Between 1987 and 1994, 39 patients underwent 41 replacements (2 reoper ations) of the aortic valve and ascending aorta by composite grafts wi th mechanical valves. One patient had annuloaortic ectasia, one had a sinus of valsalva aneurysm, 13 patients had a DeBakey type I acute dis section, 10 had a DeBakey type II acute dissection including two Marfa n patients, and 14 had atherosclerotic aneurysms. 6 patients (15%) die d within a postoperative period of 30 days. The mean follow-up time wa s 40 months (1-82 months). Twenty-six patients were restudied by clini cal examinations and computed tomography of the chest (CT). Two patien ts required emergency reoperation due to disruption of the proximal ao rtic anastomosis and right coronary anastomosis. Both patients had bee n diagnosed to have Marfan disease. Anastomotic dehiscence of composit e grafts has a potentially high risk of lethal complications. In follo w-up examination computed tomography was performed as a simple and acc urate method to detect complications such as pseudoaneurysms, but up t o now did not give the indications for reoperation. We suggest that co mplications may occur not only in the early postoperative period so th at regular CT-scan control studies (every 6 to 12 months) should be pe rformed in all patients who undergo composite graft replacement.