Composite graft replacement of the aortic root: Long-term results, incidence of reoperations

Background: Long-term results after composite graft replacement of the aort ic root may depend on the insertion technique. Methods: 181 consecutive pat ients (mean age 53 years; 153 men) operated on between 1983 and 1993 were s tudied. Indications for surgery were annuloaortic ectasia (n=98), acute aor tic dissection (n = 46), other indications (n =12), and various indications after previous aortic valve replacement (n = 25). Mean followup was 28 mon ths. The open-button technique was performed in 74 patients (41%) and the B entall inclusion technique in 107 patients (59%), with a Cabrol shunt to th e right atrium in 16 patients. Results: Overall survival was 75% after 7 ye ars, significantly decreased in acute aortic dissection (p = 0.0019) and wi thout difference between the two surgical techniques (p = 0.3166). Reoperat ion-free survival was 69% at 7 years and significantly decreased after acut e dissection (p = 0.0421). Pseudo aneurysm formation only occurred in 3 pat ients operated with the Bentall technique not including a Cabrol shunt. Con clusions: Long-term results are satisfactory. In acute aortic dissection su rvi vat is decreased and late reoperations more frequent. The open techniqu e is safe in non-dissection and in acute dissection and avoids pseudoaneury sm formation. The Bentall technique combined with Cabrol shunt is indicated if there is a high risk of hemorrhage. Long-term monitoring of the aorta i s mandatory in patients with acute dissection and/or Marfan disease.