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Ann Thorac Surg 2002;74:S1765-S1768
© 2002 The Society of Thoracic Surgeons
a Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany
* Address reprint requests to Dr Kallenbach, Hannover Medical School, Department of Thoracic and Cardiovascular Surgery, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
e-mail: kallenbach{at}thg.mh-hannover.de
Presented at the Aortic Surgery Symposium VIII, May 2–3, 2002, New York, NY.
Abstract
BACKGROUND: To assess the feasibility and outcome of the valve-sparing aortic root reimplantation technique in patients with severe preoperative aortic insufficiency (AI).
METHODS: Within 8 years we have operated on 158 patients with aneurysms of the ascending aorta using the reimplantation technique. We identified 83 patients with AI grade 3 or 4 (mean 3.1 ± 0.4) preoperatively (study group). This cohort was compared with 71 patients with AI grade 2 or less (mean 1.3 ± 0.9; control group) with regard to mortality, operative variables, complications, need for reoperation, postoperative AI, and clinical presentation during follow-up.
RESULTS: Patient demographics were comparable in both groups. However, Marfan’s syndrome (32% versus 13%, p = 0.006) and acute type A aortic dissection (20% versus 8.4%, p = 0.059) were more frequent in the control group. In addition, bypass (177 ± 60 minutes versus 160 ± 36 minutes, p = 0.022) and cross clamp times (133 ± 34 minutes versus 124 ± 27 minutes, p = 0.049) were significantly longer in controls. Mortality was low in the study group and comparable with controls (30-day, 3.6% versus 4.2%; during follow-up, 3.8% versus 5.9%; p = not significant [NS]). Reoperation rate was almost identical in both groups (3.8% versus 4.4%, p = NS). Mean grade of AI was significantly higher in the study group early postoperatively (0.31 ± 0.46 versus 0.18 ± 0.42, p = 0.049) but comparable at the last visit (0.43 ± 0.58 versus 0.42 ± 0.62, p = NS). During follow-up neither thromboembolic complications nor bleeding events were noted in either group. Clinical performance at the last visit revealed no significant difference between the groups.
CONCLUSIONS: Preoperative severe aortic insufficiency does not impair the excellent outcome seen after a mean of 3 years of follow-up in patients undergoing the reimplantation technique for valve-sparing aortic root reconstruction.
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