REPLACEMENT OF THE ASCENDING AORTA AND AORTIC-VALVE WITH A COMPOSITE GRAFT - OPERATIVE AND LONG-TERM RESULTS

The purpose of this study is to analyze our treatment experience on pa tients with ascending aortic aneurysms, with aortic regurgitation. Fro m January 1974 to December 1995, 49 patients underwent replacement of the aortic valve and ascending aorta with a composite graft, in which primary operation cases were 44 and reoperation ones were 5. The Benta ll technique was used in 20 patients, the button technique in Il, the interposition graft technique in 11, and a combination of the interpos ition graft and button technique in 7. All but one reoperation cases u nderwent the interposition graft technique. Hospital mortality was 30% for the Bentall technique, and 9.1% for the button technique and 9.1% for the interposition graft technique; there was no hospital mortalit y in the combination of the interposition graft and button technique. Hospital mortality of interposition graft technique in primary operati on cases was 9.1%, and that in reoperation cases was 0%. Hospital mort ality in patients underwent from 1974 to 1985 was 30.8%, 27.8% from 19 86 to 1991, and 0% from 1992 to 1995. Five late deaths occurred in the Bentall group (35.7%) and one late death in the button technique (9.1 %). No late deaths in the other groups have occurred. In summary, oper ative mortality in Bentall technique group was higher than that of the other groups. Operative results were improved by the change of operat ive methods. The interposition graft technique is preferable for patie nts undergoing reoperation or when tension on the ostial anastomoses m ay occur. The button technique is best for patients with aortic dissec tion or inflamation involving the coronary ostia. (C) 1998 Tohoku Univ ersity Medical Press.