Aortic root replacement with coronary button re-implantation: low risk andpredictable outcome

Objective: Cardiac morbidity in aortic root replacement often occurs throug h myocardial ischaemia. We analyzed a 10 year experience of all root replac ement operations by one surgeon to determine the incidence of coronary comp lications and risk factors for early mortality. Methods: The study included 140 aortic root replacement patients (aged from 2 to 77 years; median 53 y ears) operated between 1988 and 1999. Thirty-four had Marfan's syndrome. El even had root infection requiring homograft replacement. Nineteen were reop erations (14%). Concomitant procedures were arch replacement (16), mitral r eplacement (five), and coronary bypass (22). Mobilization and reimplantatio n of the coronary ostia was performed in 139 patients. We performed the dis tal graft anastomosis before right coronary reimplantation. Results: There were eight hospital deaths (5.7%). Risk factors for hospital mortality were : preoperative NYHA class IV, shock, LVEF less than or equal to 30%, acute dissection, concomitant mitral valve replacement, pump time greater than or equal to 160 min, reentry for bleeding, and postoperative renal failure. N either myocardial ischaemia nor right ventricular dysfunction contribute to mortality. There were 18 late deaths with an actuarial survival of 79% at 5 years. There were no late coronary false aneurysms. Conclusions: Button r eimplantation with the sequence described is predictable and safe. Wrap-aro und is unnecessary. Coronary aneurysms have been eliminated. (C) 2000 Elsev ier Science B.V. All rights reserved.