COMPOSITE GRAFT REPLACEMENT OF THE AORTIC ROOT IN 335 PATIENTS WITH ANEURYSM OR DISSECTION

The hypothesis that replacement of the aortic root with a valved compo site graft is a safe and effective therapy for aneurysms involving the sine-tubular segment of the aorta was tested by a retrospective revie w. From September 1978 to January 1995, 335 consecutive patients under went prosthetic aortic root replacement as the primary operation for a neurysm (222) or dissection (acute 59, chronic 54). There were 248 men (74%) and 87 women (26%) with a mean age of 50 +/- 14 years. 22 patie nts (6.6%) experienced hospital death primarily due to cardiac causes. Mortality was significantly higher in patients with acute dissection versus those with non-dissecting aneurysms and chronic dissection. Sex , Marfan syndrome (20.3% of patients), mitral regurgitation, coronary artery disease, and era of operation had no effect on early outcome. M ortality was significantly increased in patients aged over 50 years, i n those with circulatory compromise, and in patients requiring emergen cy operation. Follow-up was complete in 313 survivors (97%) at a mean of 61.3 +/- 44 months. Actuarial survival was 80% at 5 and 67% at 10 y ears. There were no complications involving the coronary anastomoses, other than infection-related, regardless of the mode of ostial reattac hment.