Details

Autor(en) / Beteiligte

• Bachet, J
• Termignon, J L
• Goudot, B
• Dreyfus, G
• Piquois, A
• Brodaty, D
• Dubois, C
• Delentdecker, P
• Guilmet, D

Titel

Aortic root replacement with a composite graft. Factors influencing immediate and long-term results

Ist Teil von

• European journal of cardio-thoracic surgery, 1996-03, Vol.10 (3), p.207-213

Ort / Verlag

Germany: Elsevier Science B.V

Erscheinungsjahr

1996

Quelle

Oxford Journals 2020 Medicine

Beschreibungen/Notizen

• From April 73 to June 94, 203 patients (167 men, 36 women) aged from 10to 74 years (mean: 44.8 +/- 15) underwent ascending aortic replacement withcomposite graft for: dystrophic aneurysm (AN) (130 cases, 64.5%), chronicdissection (CD) (35 cases, 17.2%), type A acute dissection (AD) (38 cases,18.7%). Forty-six patients (22.6%) suffered from Marfan syndrome (24 AN, 13AD, 9 CD). Thirty patients (14.7%) had undergone a previous cardiac oraortic operation. The ascending aortic replacement was extended to thetransverse arch in 28 patients (13.7%). A mechanical valve was used in 193cases (95%). Since 1986, the ascending aorta has been totally resected anda gelatin-or collagen-coated vascular prosthesis used. The technique ofcoronary reattachment has varied with time and according to the aorticlesions. The classic "Bentall" technique was used in 87 patients (43%), the"button" technique in 74 (36%), the "Cabrol" technique in 26 (13%) and a"mixed" technique in 16 cases (8%). The hospital mortality rate was 7.3%(15/203) (AN: 2.3%, CD: 11.4%, AD: 21%). The only predictors of hospitaldeath were emergency AD (P < 0.03) and arch replacement (P < 0.02).Mean follow-up was 46 +/- 10 months (2-246). The overall long- termsurvival rate was (Kaplan Meier) 89 +/- 6% at 1 year, 77.9 +/- 9% at 5years, 67.7 +/- 12% at 10 years and 61.3 +/- 15% at 12 years. The 10-yearsurvival rate is significantly higher in patients with AN (77.8 +/- 11%)than in those with AD (61.6 +/- 17%) (log. rank: P < 0.01). The latesurvival rate is also significantly higher after the "button" or Bentallreimplantation than after the "Cabrol" or "mixed" methods (90 +/- 5% in the"button" group and 88.7 +/- 6%, 83.8 +/- 9% and 76.6 +/- 12% in the"Bentall" group vs 80 +/- 18%, 63 +/- 21% and 58 +/- 35% in the "Cabrol"group at 1, 5 and 8 years, respectively). In conclusion, ascending aorticreplacement with a composite graft is a safe procedure especially whenperformed electively in patients with dystrophic aneurysm or Marfansyndrome. The technique of coronary reimplantation has a significantinfluence on the long-term results. The reimplantation of choice is the"button" technique, especially in the presence of a fragile aortic wall(AD). The "Cabrol" technique must be used when the "button" or the"Bentall" reimplantation is not feasible, for instance during redoprocedures.