Operation for ascending aortic aneurysm and aortic regurgiation —Pathological influence on survival—

Abstract

The author briefly reviews the early operations of treatment of aortic aneurysm and aortic regurgitation leading to his description, in 1968, of the first composite graft replacement of the ascending aorta and aortic valve, with anastomosis of the coronary arteries into the graft. The original operation is described with reference to modifications suggested by a number of authors throughout the last 20 years. Methods of achieving coronary artery continuity by Carrel patch and pull-through by saphenous vein interposition and by synthetic graft techniques are discussed. While any of these methods may be needed in individual cases the preference of the author remains for simplicity. The arguments for and against excision of the aneurysmal sac are considered in relation to the control of haemorrhage. The early and medium term results of operation are good but in comparing results world-wide a lack of uniform diagnostic criteria is apparent. The full clinical Marfan syndrome presents little difficulty but the status of "annuloaortic ectasia", Erdheim's medionecrosis, "cystic medial necrosis" and many other pathological descriptions are not defined: "forme fruste" of Marfan's disease has been used for any of the above. Interpretation of surgical results remains difficult and often impossible in the absence of clear definitions. Recent work on elastic tissue and on the chemistry of collagen together with the hope of identification of the genetic background now offers real hope of clearer understanding.

Ascending aortic aneurysm and aortic valve dysfunction in bicuspid aortic valve disease

“…Severe AVD was present with previous aortic valve replacement or aortic valve reconstruction or with previous percutaneous balloon aortic valvuloplasty [9] as detailed in Table 1. ACA was present with previous aortic surgery comprising ascending aortic reduction aortoplasty both with (3 patients) or without external reinforcement (7 patients) [10], isolated supracoronary replacement of the ascending aorta (2 patients), supracoronary replacement of the ascending aorta combined with aortic valve replacement according to Wheat (6 patients) [11], replacement of the ascending aorta and aortic valve with a valved conduit and direct reimplantation of the coronary arteries according to Bentall (4 patients) [12], or a valve-sparing root replacement according to David and as classified David-I according to Miller (4 patients; Table 1) [13].…”

The utility of multiple imaging modalities to diagnose acute aortic dissection

“…The patient was admitted to the intensive care unit and underwent repair with the Bentall procedure. 6 Postoperatively, he developed anterior compartment syndrome in the right leg, necessitating fasciotomy. He recovered well and was discharged home in stable condition.…”