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Twenty-five year outcomes following composite graft aortic root replacement.

Authors :
Mok, Salvior C.M.
Ma, Wei‐Guo
Mansour, Ahmed
Charilaou, Paris
Chou, Alan S.
Peterss, Sven
Tranquilli, Maryann
Ziganshin, Bulat A.
Elefteriades, John A.
Source :
Journal of Cardiac Surgery; Feb2017, Vol. 32 Issue 2, p99-109, 11p, 4 Charts, 6 Graphs
Publication Year :
2017

Abstract

<bold>Background: </bold>Operative choices for aortic root disease include traditional root replacement with a composite valved graft as well as various valve-sparing and root repair procedures.<bold>Objectives: </bold>To report our experience with traditional composite graft aortic root replacement by a single surgeon over a 25-year period in 449 patients, focusing on long-term survival and freedom from late reoperation and adverse events.<bold>Methods: </bold>The coronary button technique was used in all patients. Mean age was 56.1 ± 14.0 years (range 14-87) with 83% males (373/449). Valve prosthesis was mechanical in 343 (76%) and bioprosthetic in 106 (24%). A modified Cabrol procedure (Dacron coronary graft) was employed in 10% (45/449) and concomitant coronary artery bypass graft in 10.9% (49/449). There were 15.8% (71/449) urgent/emergent and 8.2% (37/449) redo procedures. Survival follow-up was 100%. Mean follow-up was 7.0 ± 5.1 years (range 0.1-24.8).<bold>Results: </bold>Operative mortality occurred in 14 patients (3.1%) and was 2.2% (9/418) in non-dissection and 1.9% (7/361) in elective first-time operations. Stroke and re-exploration for bleeding occurred in nine (2.0%) and 20 (4.5%) patients, respectively. Major late events included bleeding in 2.5% (11/435) and thromboembolism in 1.1% (5/435). At 5, 10, and 20 years, freedom from major events and reoperations on the root were 97.8, 95.4, and 94.39%, and 99.0, 99.0, and 97.9%, respectively. Survival in patients aged <60 years was 92.0, 90.1, and 79.8% at five, 10, and 20 years versus 88.4, 67.9, and 42.6% in patients aged ≥60 years (p = 0.001). Compared with age- and gender-matched controls, survival was not significantly different (p = 0.20).<bold>Conclusions: </bold>Composite graft aortic root replacement is associated with low operative risk, excellent long-term survival, and low incidence of reoperation and late events. [ABSTRACT FROM AUTHOR]

Details

Language :
English
ISSN :
08860440
Volume :
32
Issue :
2
Database :
Complementary Index
Journal :
Journal of Cardiac Surgery
Publication Type :
Academic Journal
Accession number :
121147472
Full Text :
https://doi.org/10.1111/jocs.12875