The Thoracic and cardiovascular surgeon · 1999
Composite graft replacement of the aortic root: long-term results, incidence of reoperations.
СтатьяНазвание и аннотация: Перевод в очереди
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Niederhäuser U, Künzli A, Genoni M, Vogt P, Lachat M, Turina M
Аннотация
BACKGROUND: Long-term results after composite graft replacement of the aortic root may depend on the insertion technique.
METHODS: 181 consecutive patients (mean age 53 years; 153 men) operated on between 1983 and 1993 were studied. Indications for surgery were annuloaortic ectasia (n=98), acute aortic dissection (n = 46), other indications (n = 12), and various indications after previous aortic valve replacement (n = 25). Mean follow-up was 28 months. The open-button technique was performed in 74 patients (41 %) and the Bentall inclusion technique in 107 patients (59%), with a Cabrol shunt to the right atrium in 16 patients.
RESULTS: Overall survival was 75% after 7 years, significantly decreased in acute aortic dissection (p = 0.0019) and without difference between the two surgical techniques (p = 0.3166). Reoperation-free survival was 69% at 7 years and significantly decreased after acute dissection (p = 0.0421 ). Pseudoaneurysm formation only occurred in 3 patients operated with the Bentall technique not including a Cabrol shunt.
CONCLUSIONS: Long-term results are satisfactory. In acute aortic dissection survival is decreased and late reoperations more frequent. The open technique is safe in non-dissection and in acute dissection and avoids pseudoaneurysm formation. The Bentall technique combined with Cabrol shunt is indicated if there is a high risk of hemorrhage. Long-term monitoring of the aorta is mandatory in patients with acute dissection and/or Marfan disease.
METHODS: 181 consecutive patients (mean age 53 years; 153 men) operated on between 1983 and 1993 were studied. Indications for surgery were annuloaortic ectasia (n=98), acute aortic dissection (n = 46), other indications (n = 12), and various indications after previous aortic valve replacement (n = 25). Mean follow-up was 28 months. The open-button technique was performed in 74 patients (41 %) and the Bentall inclusion technique in 107 patients (59%), with a Cabrol shunt to the right atrium in 16 patients.
RESULTS: Overall survival was 75% after 7 years, significantly decreased in acute aortic dissection (p = 0.0019) and without difference between the two surgical techniques (p = 0.3166). Reoperation-free survival was 69% at 7 years and significantly decreased after acute dissection (p = 0.0421 ). Pseudoaneurysm formation only occurred in 3 patients operated with the Bentall technique not including a Cabrol shunt.
CONCLUSIONS: Long-term results are satisfactory. In acute aortic dissection survival is decreased and late reoperations more frequent. The open technique is safe in non-dissection and in acute dissection and avoids pseudoaneurysm formation. The Bentall technique combined with Cabrol shunt is indicated if there is a high risk of hemorrhage. Long-term monitoring of the aorta is mandatory in patients with acute dissection and/or Marfan disease.