During 1978, 42 consecutive patients underwent simultaneous aortic valve and ascending aorta replacement in our institution. Seventy-one percent were at low risk despite a high incidence of dissection. Twenty-nine percent were high-risk patients requiring repeat or concomitant cardiac procedures, mostly on an emergency basis. Depending on the extent of the disease at the aortic root, either of 2 surgical approaches was used: (1) conventional aortic valve and supracoronary ascending aorta replacement, with or without right coronary artery ostium reimplantation, or (2) insertion of a composite graft containing an aortic valve prosthesis, with reconstruction of both coronary arteries. Preservation of coronary ostia was possible in 85% of the patients, and composite grafts wereused in 15%. The conventional method was associated with a higher percentage of survivors. This technique was found to be satisfactory unless severe dilatation or complete destruction of the aortic annulus made composite grafting necessary. The latter technique was associated with fewer re-explorations for postoperative hemorrhage. Both procedures were equally effective, resulting in an operative mortality of 10% in uncomplicated situations. Surgery appeared to offer the only chance of survival for the high-risk group, and half of these patients were salvaged.

Between 1972 and 1978, 429 patients underwent intraaortic balloon pump (IABP) counterpulsation in our institution. Ninety-six were women (22.4). The overall mortality was 52.9% for men and 69.8% for women. During 1978, however, the mortality for women decreased to 57.1%, even though they comprised a larger percentage of patients (28.2%) than before. The major indication for IABP support in these women was ischemic myocardial dysfunction resulting in failure to wean from cardiopulmonary bypass (THI hemodynamic Classification C) despite volume expansion and pharmacologic support. Improved results were obtained with the use of larger intraaortic balloons and direct ascending aortic IABP insertion (which allowed use of larger, more effective 30 or 40 ml balloons), combined with delayed sternal closure.

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