Midterm thromboembolic and bleeding complications are minimal after composite graft replacement of the aortic root

Abstract

The rationale for the Ross procedure and for valve-sparing aortic root procedures is predicated on the presumption that traditional composite graft replacement of the aorta and aortic valve will be complicated by late thromboembolism and by warfarin-related bleeding. We evaluated this presumption by determining late followup after composite graft replacement of the ascending aorta and aortic valve. One hundred six consecutive patients (21 female, 85 male) underwent composite graft replacement between January 1995 and November 2004. Mean age was 54.5 years. Indication for surgery was chronic aneurysm in 93 patients and acute type A dissection in 13. St. Jude mechanical valve conduit was used in 95 (89.6%) patients (mean size ¼ 23 mm, range-19-31 mm), whereas 11 patients (10.4%) received a biological conduit (mean size-23 mm, range-19-27 mm). Warfarin goal for the St. Jude group was INR 1.8-2.2. Hospital mortality was 5.6% (6/106), including stroke 2.8% (3/106) and bleeding 1.8% (2/106). In-hospital morbidity was 12.2% (13/106). With a postoperative followup ranging from 1 to 114 months (mean-44.4), late causes of death were stroke in two patients (2%). Kaplan-Meier curves show five-year postdischarge survival at 97.3% and eightyear survival at 91.2%. Event-free survival was 89.3% at five years followup and 76.2 at eight years.Thromboembolism and bleeding complications were minimal in midterm followup after composite graft replacement. This information renders composite graft replacement relatively more attractive versus the surgical alternatives than previously appreciated.

Late Anatomic Findings after “Rescue CABG” for Peri-Operative Ischemia Following Aortic Root Replacement

“…The advent of direct coronary button reimplantation has enhanced safety and durability of the procedure [2,3]. The overall mortality associated with ARR is now in the range of 2% -6% in recent studies [3][4][5][6][7][8][9]. In series presented in this clinical report, this procedure was very safe, with an overall mortality of only 2.95%.…”

“…However, aortic root replacement procedures still carry some peri-operative risk, with experienced centers noting contemporary operation-related mortality of 2% to 6% [3][4][5][6][7][8][9]. In a previous paper, we highlighted the potential problems related to attachment of the coronary artery buttons that can produce acute ischemia in the operating room or shortly thereafter, thus jeopardizing immediate survival [8].…”