Composite graft replacement of the aortic root in 335 patients with aneurysm or dissection.

The hypothesis that replacement of the aortic root with a valved composite graft is a safe and effective therapy for aneurysms involving the sino-tubular segment of the aorta was tested by a retrospective review. From September 1978 to January 1995, 335 consecutive patients underwent prosthetic aortic root replacement as the primary operation for aneurysm (222) or dissection (acute 59, chronic 54). There were 248 men (74%) and 87 women (26%) with a mean age of 50 +/- 14 years. 22 patients (6.6%) experienced hospital death primarily due to cardiac causes. Mortality was significantly higher in patients with acute dissection versus those with non-dissecting aneurysms and chronic dissection. Sex, Marfan syndrome (20.3% of patients), mitral regurgitation, coronary artery disease, and era of operation had no effect on early outcome. Mortality was significantly increased in patients aged over 50 years, in those with circulatory compromise, and in patients requiring emergency operation. Follow-up was complete in 313 survivors (97%) at a mean of 61.3 +/- 44 months. Actuarial survival was 80% at 5 and 67% at 10 years. There were no complications involving the coronary anastomoses, other than infection-related, regardless of the mode of ostial reattachment.