COMPOSITE VALVE GRAFT REPLACEMENT OF THE ASCENDING AORTA AND THE AORTIC-VALVE BY A MODIFIED BUTTON TECHNIQUE - THE INFLUENCE OF AORTIC PATHOLOGY ON EARLY MORTALITY AND LATE SURVIVAL

The risk factors for in-hospital mortality and mid-term survival in pa tients undergoing composite graft replacement of the aortic root with reimplant of coronary arteries by a modified button technique were eva luated with special emphasis on the underlying aortic pathology. Betwe en 1985 and 1993 74 patients underwent replacement of the ascending ao rta and the aortic valve following a modified button technique. The pa tients were divided into three groups according to aortic pathology: a nnuloaortic ectasia (43, 58%), type A dissection (18, 24%), and miscel laneous (13, 18%). In-hospital mortality rates were 4,7%, 33,3% and 23 ,1%, respectively (P = 0.011). Univariate analysis showed that aortic pathology, NYHA class, emergency operation, redo operation, acute aort ic dissection, preoperative cardiogenic shock, preoperative cardiac ta mponade, longer cardiopulmonary bypass (CPB) and aortic cross-clamp ti mes, and the need of femoral vein or femoral artery cannulation at int ervention had univariate influence on in-hospital mortality. Multivari able stepwise logistic regression analysis identified CPB time odds ra tio (OR)= 1.021/min, P = 0.007), the need of femoral vein cannulation at intervention (OR = 4.85, P = 0.008) and preoperative cardiac tampon ade (OR = 3.11, P = 0.07) as independent predictors of in-hospital dea th. Follow-up ranged from 1 to 98 months (mean 39 +/- 30 months), with an actuarial survival rate of 75 +/- 9%, 52 +/- 13% and 67 +/- 14% at 5 years in annuloaortic ectasia, type A dissection, and miscellaneous patients, respectively (P = 0.18); when survival was evaluated in hos pital survivors only, Kaplan-Meier survival rates were 77 +/- 9%, 79 /- 14% and 89 +/- 10% at 5 years (P = 0.87). Comparing survival of ann uloaortic ectasia patients (5-year survival 75 +/- 9%) versus survival of all other patients pooled together (5-year survival 55 +/- 11%), t here was a statistically significant difference (P < 0.05); such a dif ference was no longer significant when comparing hospital survivors al one (5-year survival rate 77 +/- 9% annulo-aortic ectasia patients vs 79 +/- 12% all other patients P = 0.61). Although aortic root replacem ent carries higher in-hospital mortality in some high-risk subgroups o f patients, mid-term survival seems to be less affected by aortic path ology; high-risk patients are expected to have an out-hospital outcome comparable to the low-risk ones.