Aortic root replacement

Objective To report our operative experience with aortic root replacement i n 231 patients with aortic root aneurysm and discuss the current indication s, methods, and surgical techniques. Methods Between January 1994 and August 1999, a group of 231 consecutive pa tients underwent aortic root replacement at our hospital, with 13 being tre ated on an emergency basis. There were 189 men and 42 women, ranging in age from 14 to 69 years. The diameter of the aneurysm varied from 4.5 to 11 cm . Among this group, 145 had isolated aortic root aneurysms, 65 suffered fro m DeBakey type I aortic dissection, and the remaining 21 were diagnosed as having DeBakey type II aortic dissection. Aortic valve regurgitation occurr ed in all cases. Aortic root replacement was performed with composite valve d graft in 229 patients, and in 2 patients the aortic valve was preserved. Results The hospital mortality rate was 3.03% (7 patients). Early complicat ions included re-exploration for bleeding in 6 patients, pericardial effusi on in 9, as well as cerebral infarction, pleural effusion, and pneumothorax in 2 patients each. One hundred and seventy-five patients (78.12%) were fo llowed up, with a mean follow-up time of 15.7 +/- 13.1 months (range, 2 wee ks to 65 months). One patient died from lower-limb embolism and renal dysfu nction 3 months postoperatively. Three patients died from postoperative ant icoagulation accidents. The preoperative and postoperative mean left ventri cular end-diastolic diameters were significantly different (68.1 +/- 9.4 mm , range 54 to 112 mm; vs 54.8 +/- 8.2 mm, range 38 to 88 mm; P < 0.001). Conclusions Once a diagnosis of acute aortic root dissecting aneurysm is ma de, the patient should undergo surgery as soon as possible if the general c onditions permit. Aortic aneurysm without dissection or with chronic dissec tion should be operated if the diameter of the aneurysm is greater than 5 c m.