A 23-year experience with composite valve graft replacement of the aortic root

Background. This is a retrospective study of early and long-term results of composite valve graft replacement of the aortic root. Methods and Results. Between July 1974 and July 1997, 244 patients underwen t aortic root replacement with a composite valve graft. Mean age was 54 +/- 15 years. The inclusion technique was used in 178 patients (73.0%), the op en technique in 65 (26.5%), and the Cabrol II technique in 1 patient (0.5%) . Hospital mortality was 7.8% (70% confidence limit, 6.1% to 9.5%). Indepen dent determinants of hospital mortality were preoperative creatinine level more than 150 mu mol/L (p = 0.04), prolonged cardiopulmonary bypass time (p = 0.006), intraoperative technical problems (p = 0.048), and year of opera tion (p = 0.015). Follow-up was 99.6% complete, median 96 months (range, 2 to 256 months). Fifty-seven patients (25.3%; 70% confidence limit, 22.4% to 28.2%) died during follow-up. Cumulative survival at 5, 10, and 20 years w as 76%, 62%, and 33%. Independent risk factors for late death were postoper ative complications (p = 0.027), technique for coronary reattachment (p = 0 .028), and concomitant aortic arch operation (p = 0.01). Twenty patients (8 .8%; 70% confidence limit, 7.0% to 10.6%) underwent reoperation on the aort ic root. Estimated freedom from reoperation for pseudoaneurysms at 3 years was 96% in the inclusion group and 94% in the open group (p = 0.236). Conclusions. Aortic root replacement with a composite valve graft can be pe rformed with low hospital mortality and morbidity. Pseudoaneurysms did occu r in the inclusion group, but also in the open group.