Total repair of annulo‐aortic ectasia with composite graft and reimplantation of coronary ostia: A consecutive series of 41 patients

Abstract

Replacement of the ascending aorta and the aortic valve with a composite graft, including reimplantation of the coronary ostia, was carried out in 41 consecutive patients with annulo-aortic ectasia from 1975 to 1984. Thirty-seven patients were operated on electively and 4 of these had a chronic dissection. Four patients underwent an emergency operation, 1 for a ruptured aneurysm and 3 for an acute dissection. The operative procedure was identical in each case. The aortic valve and the aneurysm were resected, the coronary ostia were dissected free, mobilized, and then implanted to the tube prosthesis. There was no hospital mortality. Re-sternotomy was done in 3 patients for excessive postoperative bleeding. Two patients required a permanent pacemaker owing to a total atrioventricular block. No pseudoaneurysms at the coronary ostia or the distal aortic anastomosis were observed at control aortography carried out in each patient 6 months after surgery. One patient died 3 months after the operation because of multiple emboli. All the other patients have been symptom free during follow-up. It is concluded that total repair using the technique described is feasible in all patients with annulo-aortic ectasia and gives good early and late results.

Surgical correction and prognostic factors for ascending aortic lesions involving coronary arteries

“…Good surgical results using Bentall's [3] or its modified procedure [4][5][6] for patients with AAE have been reported. Coronary artery disease [7], arrhythmia [8], or low cardiac function may influence early surgical outcomes in patients with aortic root replacement.…”

Early and late outcomes after open ascending aortic surgery: 47-year experience in a single centre

“…Age was classified into ≤ 40 (14.7% of patients), 41–50 (13.9%), 51–60 (27.5%), 61–70 (29.4%) and ≥ 70 (14.4%) years. Four categories were created according to the surgical approach that was used or intended to use on the patient: modified Bentall procedure which involves replacement of the ascending aorta and aortic root with a composite tube graft and valve prosthesis (biological or mechanical) and coronary reimplantation as described by Inberg et al [ 14 ]; modified Bentall procedure with concomitant coronary bypass (CABG) and/or mitral valve replacement (MVR) was classified as modified Bentall + CABG/MVR; valve-sparing David or Yacoub procedure with coronary reimplantation; isolated interposition with a tube graft of the ascending aorta and lastly hemiarch if the inner curvature of the aortic arch was replaced or total arch if distal anastomosis lied distal to the left subclavian artery with arch vessel reimplantation either separately or as islands. The indication for surgery was classified into those who had acute or chronic ascending aortic dissection, aortic rupture or intramural haematoma (i.e.…”

“…In the 1970s, a modified Bentall technique, as described by Inberg et al [ 14 ], was adopted in Turku university hospital for reconstruction of the root and ascending aorta and thereafter was used as the preferred approach for root replacement in both acute and elective cases. In cases of a competent valve and minimal root involvement, an isolated supracoronary replacement of the ascending aorta was used.…”

Results of Cardiovascular Surgery in the Marfan Syndrome:A Retrospective Study of 49 Patients

“…The method of aortic root replacement was modified from that described by Bentall and D e Bono in 1968 (2). The method (11) has been used by our team since 1975. The method (11) has been used by our team since 1975.…”