Composite valve graft replacement of the ascending aorta and the aortic valve by a modified button technique: the influence of aortic pathology on early mortality and late survival

Abstract

The risk factors for in-hospital mortality and mid-term survival in patients undergoing composite graft replacement of the aortic root with reimplant or coronary arteries by a modified button technique were evaluated with special emphasis on the underlying aortic pathology. Between 1985 and 1993 74 patients underwent replacement of the ascending aorta and the aortic valve following a modified button technique. The patients were divided into three groups according to aortic pathology: annuloaortic ectasia (43.58%), type A dissection (18.24%), and miscellaneous (13.18%). In-hospital mortality rates were 4.7%, 33.3% and 23.1%, respectively (P = 0.011). Univariate analysis showed that aortic pathology, NYHA class, emergency operation, redo operation, acute aortic dissection, preoperative cardiogenic shock, preoperative cardiac tamponade, longer cardiopulmonary bypass (CPB) and aortic cross-clamp times, and the need of femoral vein or femoral artery cannulation at intervention had univariate influence on in-hospital mortality. Multivariable stepwise logistic regression analysis identified CPB time odds ratio (OR) = 1.021/min, P = 0.007), the need of femoral vein cannulation at intervention (OR= 4.85, P = 0.008) and preoperative cardiac tamponade (OR = 3.11, P = 0.07) as independent predictors of in-hospital death. Follow-up ranged from 1 to 98 months (mean 39 +/- 30 months) with an actuarial survival rate of 75 +/- 9%, 52 +/- 13% and 67 +/- 14% at 5 years in annuloaortic ectasia, type A dissection, and miscellaneous patients, respectively (P = 0.18); when survival was evaluated in hospital survivors only, Kaplan-Meier survival rates were 77 +/- 9%, 79 +/- 14% and 89 +/- 10% at 5 years (P = 0.87). Comparing survival of annuloaortic ectasia patients (5-year survival 75 +/- 9%) versus survival of all other patients pooled together (5-year survival 55 +/- 11%), there was a statistically significant difference (P < 0.05); such a difference was no longer significant when comparing hospital survivors alone (5-year survival rate 77 +/- 9% annuloaortic ectasia patients vs 79 +/- 12% all other patients P = 0.61). Although aortic root replacement carries higher in-hospital mortality in some high-risk subgroups of patients, mid-term survival seems to be less affected by aortic pathology; high-risk patients are expected to have an out-hospital outcome comparable to the low-risk ones.

Long-Term Mortality and Morbidity after Button Bentall Operation

“…Since the late 1990s, pseudoaneurysm formation after the button Bentall operation have rarely been reported (Table ) . In our study, three pseudoaneurysm formations (1.6%) were detected at the graft anastomosis sites, not in the coronary button sites.…”

Early and Late Results of Ascending Aorta Surgery: Risk Factors for Early and Late Outcome

“…Patients were classified according to aortic disease into groups of aortic aneurysm, aortic dissection, and miscellaneous pathologies. The aortic aneurysm group (n ϭ 76, 48.1%) comprised those with annuloaortic ectasia [1] and atherosclerotic supracoronary aneurysms; the type A dissection group (n ϭ 72, 45.6%) included those with spontaneously occurring medial dissection, both acute and chronic; the miscellaneous group (n ϭ 10, 6.3%) contained all the patients who could not be included in one of the previous groups. Of this group, 68 (43%) underwent replacement of the supracoronary ascending aorta, 79 (50%) had a composite graft inserted, and 11 (7%) needed the ascending aorta to be replaced together with the aortic valve, sparing the aortic root; circulatory arrest was employed in 30 (19%) patients.…”

“…Patients who undergo ascending aorta surgery are a miscellaneous group depending on pathology, priority of surgery, in-hospital mortality, and late survival expectancy [1][2][3][4][5][6][7][8]. In addition, the predictors of in-hospital results frequently do not coincide with the determinants of long-term survival [2, 3, 9 -11].…”

Results of one-hundred and seventy patients after elective Bentall operation

“…[3][4][5] Although excellent results after elective indications have been reported, depending on the different aortic pathologies, the mortality and morbidity rates vary greatly in recent literature. [6][7][8][9] This variation is possibly due to different patient populations, operative techniques, and postoperative management. 10 In this retrospective study, we investigated our results of the Bentall procedure over the last 12 years.…”