Long-Term Results of Aortic Root Replacement: 15 Years' Experience

Mataracı, İlker; Polat, Adil; Kıran, Burak; Çalışkan, Ahmet; Tuncer, Altug; Erentuğ, Vedat; Kırali, Kaan; Işık, Ömer; Yakut, Cevat

doi:10.1016/j.athoracsur.2009.03.046

Cited by 21 publications

(22 citation statements)

References 15 publications

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“…The late mortality rate was significantly affected by Marfan syndrome (P=0.025). 9 These results are comparable to the results of the present study.…”

Section: Discussionsupporting

confidence: 83%

“…These same authors concluded that the Bentall procedure can be performed with excellent short-and long-term results in relatively noncomplex, elective cases in which aortic valve disease is combined with dilation of the ascending aorta. 1 Similar results have been reported by Mataraci and associates, 9 who performed the Bentall de Bono procedure on 254 patients in need of aortic root replacement. Actuarial survival for the 254 patients overall was 88.4% ± 2.1%, 87.4% ± 2.2%, and 84.5% ± 2.56% at 1, 3, and 10 years, respectively.…”

Section: Discussionsupporting

confidence: 77%

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Effect of Elective Bentall Procedure on Left Ventricular Systolic Function and Functional Status: Long-Term Follow-Up in 90 patients

Djokic¹,

Otašević²,

Mićović³

et al. 2016

Texas Heart Institute Journal

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Because there are so few data on the long-term effects on left ventricular systolic function and functional status in patients who electively undergo Bentall procedures, we established a retrospective study group of 90 consecutive patients. This group consisted of 71 male and 19 female patients (mean age, 54 ± 10 yr) who had undergone the Bentall procedure to correct aortic valve disease and aneurysm of the ascending aorta, from 1997 through 2003 in a single tertiary-care center. We monitored these patients for a mean period of 117 ± 41 months for death, left ventricular ejection fraction and volume indices, and functional capacity as determined by New York Heart Association (NYHA) class. There were no operative deaths. The survival rate was 73.3% during follow-up. There were 10 cardiac and 13 noncardiac deaths, and 1 death of unknown cause. Echocardiography was performed before the index procedure and again after 117 ± 41 months. In surviving patients, statistically significant improvement in left ventricular ejection fraction, in comparison with preoperative values (0.49 ± 0.11 vs 0.41 ± 0.11; P <0.0001), was noted at follow-up. Similarly, we observed statistically significant reductions in left ventricular end-systolic (39.24 ± 28.7 vs 48.77 ± 28.62 mL/m2) and end-diastolic volumes (54.63 ± 6.97 vs 59.17 ± 8.92 mL/m2; both P <0.0001). Most patients (53/66 [80.3%]) progressed from a higher to a lower NYHA class during the follow-up period. The Bentall procedure significantly improved long-term left ventricular systolic function and functional status in surviving patients who underwent operation on a nonemergency basis.

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“…The late mortality rate was significantly affected by Marfan syndrome (P=0.025). 9 These results are comparable to the results of the present study.…”

Section: Discussionsupporting

confidence: 83%

Section: Discussionsupporting

confidence: 77%

Effect of Elective Bentall Procedure on Left Ventricular Systolic Function and Functional Status: Long-Term Follow-Up in 90 patients

Djokic¹,

Otašević²,

Mićović³

et al. 2016

Texas Heart Institute Journal

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“…The 28 patients used for comparison had similar intraoperative myocardial ischaemic, cardiopulmonary bypass, and circulatory arrest exposure as 254 root replacements in Polat's experience. 1 We have shown that EARS obviates these potentially harmful, but necessary, surgical adjuncts to root replacement. 2 Will EARS prevent aortic dissection within the supported segment?…”

Section: Reply To Polat and Colleaguesmentioning

confidence: 99%

“…We have read the interesting article by Pepper and colleagues 1 about their experience on the external support of the aortic root in Marfan syndrome. This is a good contribution to the expanding literature about Marfan syndrome; however, there are few facts that should be clarified.…”

mentioning

confidence: 99%

External aortic root support for Marfan syndrome

Polat

Erentuğ

2010

J R Soc Med

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We have read the interesting article by Pepper and colleagues 1 about their experience on the external support of the aortic root in Marfan syndrome. This is a good contribution to the expanding literature about Marfan syndrome; however, there are few facts that should be clarified.First of all, 66 patients have been removed from the analysis for the comparison of the groups due to previous operations or re-operations. Why? Reoperation in the Marfan patients is an important fact that should be kept in mind in planning the operation. As we have reported before, 2 about 20% of our patients had R1 re-operations due to dilatations in the other segments of the aorta or mitral valve problems. Second, the follow-up data of the 20 patients are unclear. There is a figure of aortic dimensions but the time of the last postoperative examination from the time of the operation is unclear. In our report of the long-term results of the aortic root operations, Marfan syndrome was found to be associated with decreased long-term survival.3 Third, as the authors have stated, the aneurysm does not necessarily precedes aortic dissection in Marfan patients. That is why; the operation indication is lower than that of the normal population. 4 In order to take advantage of refraining from the use of anticoagulation, is it wise to take the risk of an aortic dissection in this segment? We have used similar external support for an abdominal aneurysm in one of our patients in a re-operation 2 in order to decrease the operation risk. However, a young population like this mandates a more definitive treatment in our point of view.We would like to thank the authors for their study and would like to hear their contributions to the discussion. Reply to Polat and colleaguesPolat and colleagues pose key questions about our study and the future of bespoke external aortic root support (EARS). The 66 patients excluded from analysis did not match prespecified criteria, namely a first-time, elective, aortic root operation, in the same time frame and setting. The 28 patients used for comparison had similar intraoperative myocardial ischaemic, cardiopulmonary bypass, and circulatory arrest exposure as 254 root replacements in Polat's experience. 1 We have shown that EARS obviates these potentially harmful, but necessary, surgical adjuncts to root replacement. 2Will EARS prevent aortic dissection within the supported segment? Our expectation is that it will reduce both the risk of dissection and, should it occur, the severity of its consequences. We have already shown that EARS holds the supported aortic segment at, or smaller than, its preoperative size.3 The dimensions across the three aortic sinuses were measured on duplicate magnetic resonance images of 37 non-operated Marfan patients and before and after (>1 year) images of the first 10 EARS patients. The 96 images were presented in random sequence to a radiologist blind to their identity and to the hypothesis. The stability of the external support, predicted from the characteristics of the material a...

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“…Surgical repair of aortic aneurysms is the deinitive treatment procedure with an acceptable hospital mortality and morbidity rates, complication-free long-term survival, and lesser requirement of any reintervention [13][14][15][16][17]. In spite of surgical treatment of aortic aneurysms based on open approaches, endovascular repair has gained widespread acceptance due to percutaneous applicability and is considered the irst treatment option in the last years [18].…”

Section: Aortic Aneurysmmentioning

confidence: 99%