Aortic root replacement with a composite graft: Results of 69 operations in 66 patients

Objective: Indirect re‐implantation of the left coronary artery (LCA) via an interposition graft simplifies difficult LCA re‐implantation during aortic root replacement. Little information exists regarding the results of this technique. In this study, we report our experience. Methods: Between January 2001 and July 2008, of 82 aortic root replacements, 24 (mean age 48.2 years, 83% male) used the indirect re‐implantation technique. All case notes were retrospectively analyzed. Indications for operation were; aortic root aneurysm (n = 16), acute dissection (n = 6), existent homograft calcification (n = 1), failed Ross procedure (n = 1). Reasons for indirect re‐implantation were: difficult LCA mobilization secondary to previous cardiac surgery (n = 7), short left main stem (n = 6), acute dissection (n = 6), adherence to surrounding tissues (n = 5). All patients had yearly CT or MRI follow‐up. Results: Mechanical and tissue valved conduits were implanted in 22 and two patients, respectively. Ten millimeters (n = 17) or 8 mm (n = 7) Dacron grafts were used for LCA re‐implantation. Thirty‐day mortality was 12.5%. Postoperative complications were: re‐opening for bleeding (n = 2), pericardial effusion (n = 4), renal failure (n = 1). Over a median follow‐up of 26 months (range 4 to 81), one developed a false aneurysm at the right coronary artery anastomosis five months postoperatively, which was subsequently repaired. All interposition grafts remained patent on MRI or CT. There were six late deaths. At median follow‐up survival rate was 71%. Conclusions: The indirect re‐implantation of the LCA during aortic root replacements is a reliable, safe, and effective method in dealing with the LCA in difficult circumstances. Survival at 26 months is equivalent to other series of similar patients.

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“…Median duration of hospital stay was 13 (see Refs. 6–20) days and median length of intensive care unit stay was 2 (see Refs. 1–3) days.…”

Section: Resultsmentioning

confidence: 99%

Indirect Re-Implantation of the Left Coronary Artery During Aortic Surgery

Senanayake

Cooper

2012

Journal of Cardiac Surgery

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“…12,13 Tension at the anastomosis of the coronary ostia may account for this complication. Three patients in our series required reoperation for a false aneurysm.…”

Section: Discussionmentioning

confidence: 99%

Results of Aortic Surgery in Patients with Marfan Syndrome

et al. 2005

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“…Our mortality and mid-term survival rates compare favorably with those reported by others. 2,3,10) Modified Bentall procedures are safe in general. Meticulous dissection as well as careful handling and positioning of the coronary buttons are of paramount importance in patients with a stiff aortic root since technical errors are more likely to occur.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Perioperative Risk Factors in Mortality and Morbidity after Modified Bentall Operation.

et al. 2002

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SUMMARYThe objective of the present study was to determine the risk factors for operative and short-term mortality, and morbidity after a Bentall operation. Between July 1994 and February 2001, 86 consecutive patients (70 males) underwent a modified Bentall operation at our hospital. The aortic pathology was acute aortic dissection in 12 (14%), chronic dissection in 9 (10.5%) and degenerative aneurysm in 65 (75.6%). Mean age was 48±15 years. Eleven preoperative, 8 intraoperative and 6 postoperative variables of these patients were retrospectively analyzed using univariate and multivariate logistic regression analysis. Six patients died in the hospital (6.9%) and 2 died within four months after being discharged from the hospital. Mean follow-up time was 33±23 months (2 months to 8 years). The survival rate among hospital survivors was 88% at 3 years and 77% at 6 years. Univariate predictors of in-hospital and short-term mortality were the presence of aortic valve calcification, stenotic aortic valves, renal failure, and cardiac failure after the operation. Multivariate analysis revealed no independent risk factors. Risk factors for morbidity were etiology of acute dissection, use of circulatory arrest, transfusion of blood and fresh frozen plasma more than 2 units each, cross clamp and cardiopulmonary bypass times (exceeding 90 and 140 minutes, respectively), and performing concomitant procedures.Modified Bentall procedures are safe in general. Meticulous dissection, careful handling and positioning of the coronary buttons are of paramount importance in patients with stiff aortic root since technical errors are more likely to occur. (Jpn Heart J 2002; 43: 151-157)

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Aortic root replacement with a composite graft: Results of 69 operations in 66 patients

Cited by 41 publications

References 18 publications

Indirect Re-Implantation of the Left Coronary Artery During Aortic Surgery

Indirect Re-Implantation of the Left Coronary Artery During Aortic Surgery

Results of Aortic Surgery in Patients with Marfan Syndrome

Analysis of Perioperative Risk Factors in Mortality and Morbidity after Modified Bentall Operation.

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