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The Annals of Thoracic Surgery, Vol 53, 38-45, Copyright © 1992 by The Society of Thoracic Surgeons
CT Lewis, DA Cooley, MC Murphy, O Talledo and D Vega
Bentall's technique for repair of annuloaortic ectasia has been associated
with postoperative bleeding and with false aneurysms at the anastomotic
site between the coronary orifices and valve-containing graft. To reduce
the incidence of these complications, we modified the Bentall procedure,
using a simplified technique to implant the graft and to create a fistula
between the closed perigraft space and right atrium to control bleeding. A
continuous suture of monofilament polypropylene was used to implant the
prosthetic valve ring and to anastomose the coronary orifices to the Dacron
fabric. In some instances, a brief period of hypothermic circulatory arrest
was needed to perform the distal aortic anastomosis. Among 562 patients
undergoing operation for aneurysm of the ascending aorta between January 1,
1980, and February 28, 1990, 280 underwent graft replacement with a valve-
containing composite conduit. Most (82%) had annuloaortic ectasia. In 267,
we performed a classic Bentall procedure with direct anastomosis between
the coronary orifices and fabric graft. The remaining 13 patients underwent
other procedures for coronary connection. Early mortality was 5.0%.
Reoperation for bleeding was needed in 13.2% of patients who underwent
operation before we used the right atrial fistula technique and in 4.4%
after we began to use the technique (p = 0.044). Actuarial survival was 71%
at 5 years and 65% at 7 years. For hospital survivors, it was 76% at 5
years and 70% at 7 years. During follow-up, only 9 patients have required
reoperation. A false aneurysm at the coronary anastomosis, which was
associated with prosthetic valve endocarditis, developed in 1 patient. No
permanent fistulas have developed.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Surgical repair of aortic root aneurysms in 280 patients
Department of Cardiovascular Surgery, Texas Heart Institute, Houston.
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