Long Term Outcomes of Aortic Root Replacement: 18 Years' Experience

Abstract

BackgroundWe reviewed the long-term outcomes of aortic root replacement at Asan Medical Center and investigated the predictors affecting mortality.Materials and MethodsA retrospective analysis was performed on 225 consecutive adult patients undergoing aortic root replacement with mechanical conduits (n=169), porcine aortic root prosthesis (n=23), or aortic homografts (n=33) from January 1992 to September 2009. The median follow-up duration was 6.1 years (range, 0 to 18.0 years).ResultsThe porcine root group was older than the other groups (freestyle 55.9±14.3 years vs. mechanical 46.3±14.6 years, homograft 48.1±14.7 years; p=0.02). The mechanical group had the highest incidence of the Marfan syndrome (mechanical 22%, freestyle 4%, homograft 3%; p=0.01). Surgery performed for infective endocarditis was more frequent in the homograft group (mechanical 10%, freestyle 10%, homograft 40%; p<0.001). The overall 30-day mortality was 5.3% (12/225). Actuarial survival rates in the mechanical, porcine root, and homograft groups were 79.4%, 81.5%, and 83.5% at 5 years and 67%, 61.9%, and 61.1% at 10 years, respectively (p=0.73). By multivariate analysis, preoperative diabetes mellitus, older age, and longer cardiopulmonary bypass time were independent predictors of mortality. Incidence of postoperative complications, including infective endocarditis and thromboembolism were comparable in all of the groups.ConclusionAortic root replacement can be safely performed with different types of prostheses as the outcome was not affected by the choice of prosthesis. Further studies are required to assess the long-term durability of biological prostheses.

Risk Prediction Model for Major Adverse Outcome in Proximal Thoracic Aortic Surgery

“…Major thoracic aortic surgery utilizing hypothermic circulatory arrest carries the potential risks of mortality and major morbidity, although outcomes have improved over the past few decades. For example, series of proximal aortic replacement report overall 30-day/inhospital mortality ranging from 3.7% to 12.1% [1,2,6,10,[19][20][21][22]. Not surprisingly, mortality rates are lower in elective than nonelective cases: reported elective mortality rates range from 1.7% to 7.6% [2,[6][7][8]23], whereas nonelective cases have been associated with mortality rates of 15.4% to 26%, with the highest rates being seen after acute type A aortic dissection repair, which was one of the reasons for excluding these patients in the current study [2,6,9].…”