IMMEDIATE AND LONG-TERM RESULTS OF REPLAC EMENT OF THE ASCENDING AORTA FOR ANEURYSM OR DISSECTION

Between April 1974 and November 1992, 181 patients were operated for a neurysm (106) or dissection (75) of the ascending aorta. Eighty patien ts had replacement with a valvular conduit with reimplantation of the coronary arteries (Bentall procedure), 48 had aortic valve replacement with replacement of the supra-coronary ascending aorta and 53 underwe nt isolated replacement of the ascending aorta. Twenty-nine patients ( 16 %) died in the postoperative period, mainly of myocardial or neurol ogical complications. Univariate statistical analysis completed by log istic regression analysis revealed the following predictive factors of early death : NYHA Stage IV, angina, reoperation for haemorrhage or t amponade (all < 0.05). All surviving patients were followed up (total follow-up : 788 years; mean : 62 months; range : 1 to 181 months). The re were 20 secondary deaths, 40 % of which were related to complicatio ns of aortic valve replacement. The 5 and 9 year survivals were 76 and 70 % respectively, perioperative mortality included, and 89 % of pati ents were in NYHA functional Stage I. Analysis of survival data did no t reveal any predictive factor of secondary death. Eight patients were reoperated at long-term. The operative mortality of replacement of th e ascending aorta remains high, especially in cases of dissection. The long-term results seem excellent with a low reoperation rate. Late mo rtality seems mainly due to complications of aortic valve replacement.