SURGERY OF THE ASCENDING AORTA - ANALYSIS OF RISK-FACTORS AND RESULTSOF 30 OPERATIONS IN A PRIVATE INSTITUTION

Replacement of the ascending aorta for aneurysm or dissection remains a complex challenge for cardiac surgeons. Between January 1984 and Dec ember 1993, 30 patients have had simultaneous resection of the ascendi ng aorta and aortic valve replacement. Sixteen of them had composite g raft replacement of the ascending aorta and the aortic valve with a mo dified Bentall's technique (Group I). Fourteen patients had supracoron ary artery aortic resection and aortic valve replacement (Group II). T he mean age was 50.1 +/- 15.3 years (range 23-76). There were 22 men a nd 8 women. Five patients (16.7%) had aortic dissection, six were oper ated on an emergency basis, Concomitant coronary artery disease was mo re frequently seen in Group II (5 patients) than in Group I (1 patient ), p < 0.05. Other preoperative patient characteristics did not differ . The overall perioperative mortality was 16.7% (5/30), none of them d ue to technical complications during surgery. Four patients died in Gr oup I and 1 in Group II (n.s.). Non-fatal myocardial infarction was di agnosed in 1 patient (Group I) and only one neurological complication occurred (Group I), while reexploration for bleeding was performed in 4 cases (13.3%). Four patients in Group I and two in Group II had post operatively low cardiac output, two of them necessitating intraaortic balloon pump insertion, 43% of the patients had no perioperative compl ications. At the end of follow-up (n = 25), average 6 months (range 1- 52 months), twenty-two survivors (22/25 or 88.0%) were in NYHA functio nal class 1. Simultaneous ascending aortic aneurysm repair and aortic valve replacement can be accomplished with an acceptable mortality and little morbidity.