Surgery of the ascending aorta. Analysis of risk factors and results of 30 operations in a private institution.

Replacement of the ascending aorta for aneurysm or dissection remains a complex challenge for cardiac surgeons. Between January 1984 and December 1993, 30 patients have had simultaneous resection of the ascending aorta and aortic valve replacement. Sixteen of them had composite graft replacement of the ascending aorta and the aortic valve with a modified Bentall's technique (Group I). Fourteen patients had supracoronary artery aortic resection and aortic valve replacement (Group II). The mean age was 50.1 +/- 15.3 years (range 23-76). There were 22 men and 8 women. Five patients (16.7%) had aortic dissection, six were operated on an emergency basis. Concomitant coronary artery disease was more frequently seen in Group II (5 patients) than in Group I (1 patient), p < 0.05. Other preoperative patient characteristics did not differ. The overall perioperative mortality was 16.7% (5/30), none of them due to technical complications during surgery. Four patients died in Group I and 1 in Group II (n.s.). Non-fatal myocardial infarction was diagnosed in 1 patient (Group I) and only one neurological complication occurred (Group I), while reexploration for bleeding was performed in 4 cases (13.3%). Four patients in Group I and two in Group II had postoperatively low cardiac output, two of them necessitating intraaortic balloon pump insertion. 43% of the patients had no perioperative complications. At the end of follow-up (n = 25), average 6 months (range 1-52 months), twenty-two survivors (22/25 or 88.0%) were in NYHA functional class 1. Simultaneous ascending aortic aneurysm repair and aortic valve replacement can be accomplished with an acceptable mortality and little morbidity.