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Ann Thorac Surg 1992;54:427-439
© 1992 The Society of Thoracic Surgeons

Articles

Composite valve graft replacement of the proximal aorta: Comparison of techniques in 348 patients

Lars G. Svensson, MD, PhD*, E.Stanley Crawford, MD, Kenneth R Hess, MS, Joseph S. Coselli, MD, Hazim J. Safi, MD

Department of Surgery, Baylor College of Medicine, Houston, Texas USA

* Address reprint requests to Dr Svensson, Department of Surgery, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77025.

Composite valve graft replacement of the ascending aorta is being increasingly used, although it is not clear which technique, the Bentall, Cabrol, or button, is the best method for coronary artery ostial reattachment. We retrospectively analyzed our results with respect to these three techniques in 348 consecutive patients operated on between September 17, 1979, and January 29, 1991. Variables included aortic arch replacement in 88 patients (25%), need for deep hypothermia and circulatory arrest in 119 (34%), aortic dissection in 131 (38%), acute dissection in 34 (9.8%), reoperation in 79 (23%), and insertion of St. Jude prostheses in 270 (78%). The 30-day survival rate was 91% ([equation]), the in-hospital survival rate was 90% ([equation]), and the 30-day incidence of postoperative new transient (n = 6) and permanent (n = 6) stroke was 3% ([equation]). The 30-day survival rates for each method were as follows: Cabrol, 92% ([equation]); button, 91% ([equation]); and Bentall, 91% ([equation]). On stepwise multivariate logistic regression analysis with control for operative date and independent prognostic factors, operative technique was not an independent determinant of early mortality or stroke. On late follow-up, the Kaplan-Meier 5-year survival rate was 71% with no significant difference between the groups (3-year survival: Cabrol, 76%; Bentall, 79%; and button, 81%; p = 0.28). The 3-year freedom from reoperation was 95% (Cabrol, 97%; Bentall, 91%; and button, 100%; p = 0.17). We conclude that for patients undergoing reoperation or complicated repairs or when tension on the ostial anastomoses may occur, the Cabrol technique is preferable. If feasible, however, the button technique has better long-term results for both survival and rate of reoperation. An alternative technique is to use an interposition graft to reattach the left coronary artery and excise an aortic button for the right coronary artery reattachment. This has the advantages of technical ease in reattaching the left coronary artery, good results for reattachment of the right coronary artery, minimal tension on the anastomoses, and visualization of all anastomoses.




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Modification of the aortic composite graft using the button-in technique
Ann. Thorac. Surg., April 1, 1994; 57(4): 1035 - 1036.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
T. Carrel, M. Pasic, R. Jenni, T. Tkebuchava, and M. I. Turina
Reoperations after operation on the thoracic aorta: Etiology, surgical techniques, and prevention
Ann. Thorac. Surg., August 1, 1993; 56(2): 259 - 269.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
J. Y. Neveux, P. Dervanian, T. A. Folliguet, L. Mace, and V. Guluta
Technical modification for anastomosis of low-lying coronary ostia in Bentall procedure
Ann. Thorac. Surg., August 1, 1993; 56(2): 383 - 384.
[Abstract] [PDF]

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 Ann. Thorac. Surg.Home page
J. G. Copeland III, L. J. Rosado, and S. L. Snyder
New technique for improving hemostasis in aortic root replacement with composite graft
Ann. Thorac. Surg., April 1, 1993; 55(4): 1027 - 1029.
[Abstract] [PDF]


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