Composite valve graft implantation for the treatment of aortic valve and root disease: Results in 1045 patients

Abstract

Within the limitations of this retrospective study, we can conclude that aortic root replacement for aortic root aneurysms can be performed with low morbidity and mortality and with satisfactory long-term results. Few late serious complications were related to the need for long-term anticoagulation or a prosthetic valve. Reoperation on the proximal or in the distal aorta was most commonly performed in patients with aortic dissection.

Twenty-five year outcomes following composite graft aortic root replacement

“…The 20-year survival in DiMarco's recent study was only 40.7%. 18 Overall, the long-term survival from these various reports is quite similar to those of the present study. See Table 4.…”

“…Michielon reported a 9‐year survival of 91.8%, which was similar to our results in patients aged <60 years. The 20‐year survival in DiMarco's recent study was only 40.7% . Overall, the long‐term survival from these various reports is quite similar to those of the present study.…”

“…In this study, freedom from reoperations on the aortic root was 99.0, 99.0, and 97.9% at five, 10, and 20 years, respectively. Freedom from operations on other aortic segments was understandably lower, 98.9, 96.7, and 86.5% at five, 10, and 20 years, respectively (quite similar to DiMarco's recent numbers)—reflecting the late progression of aortic disease in more distal aortic segments.…”

“…The operative mortality was 3.1% in the whole series and dropped to 2.2% during the past 10 years, which compares favorably with earlier and recent series, such as those reported by Kalkat (10.7%), Kirali (8.3%), Sioris (4%), Michielon (5.2%), Pacini (6.9%), Svensson (1%), and DiMarco (5.3%) . The “button” technique was utilized in most of these studies, with the exception of Pacini's group in which the classic Bentall technique was used in 1/3 of their patients (34.3%, 94/274) between 1978 and 2001 .…”

Waste not, want not: Bentall style

“…First, if the coronary artery orifice and the surrounding rim of aortic tissue are unaffected by the aortic dissection, then the coronary arteries can be reimplanted directly into the neoroot, such as in a Bentall procedure. 3 When considering whether to reimplant the coronary arteries, it is important to consider both the quality of the coronary button tissue and whether there is excessive tension on the coronary artery button anastomosis. Second, if the coronary button tissue is compromised by the aortic dissection, or if it appears that there would be unusual tension on the coronary artery anastomosis to the neoroot, then a Cabrol procedure can be performed.…”