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Original Articles: Adult Cardiac

Composite Valve Graft Replacement of the Aortic Root: Twenty-Seven Years of Experience at One Japanese Center

^a Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan
^b Department of Cardiothoracic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan

Accepted for publication July 14, 2008.

^_* Address correspondence to Dr Ogino, Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1, Fujishirodai, Suita, Osaka, 565-8565, Japan (Email: hogino{at}hsp.ncvc.go.jp).

Background: The aim of this study was to evaluate the early and long-term results of a composite valve graft root replacement for various aortic root diseases.

Methods: Between 1978 and 2005, 273 patients with various disorders of the aortic root underwent a composite valve graft root replacement. The mean age of the patients was 47.5 ± 13.2 years. There were 93 patients with Marfan syndrome, 56 aortitis, and 63 type A aortic dissections. Thirty-nine emergency operations and 55 redo operations were included. For the proximal anastomosis, a skirted technique was used in 157 patients. For the coronary reconstruction, Bentall's original inclusion technique was utilized in 36 patients, a direct button technique in 159, and a graft interposition technique in 63. The mean follow-up was 106 months.

Results: The in-hospital mortality was 9.5%. An emergency operation emerged as a significant predictor of early death. The actuarial survival rate was 87.0% and 72.9% at 5 and 15 years, respectively. The age at the operation, aortitis, Marfan syndrome, and use of a standard proximal anastomosis emerged as independent determinants of late death. The actuarial reoperation free rate was 96.3% and 89.7% at 5 and 15 years, respectively. In the patients who underwent the skirted technique the incidence of late graft detachment was less frequent than that of the standard technique.

Conclusions: A composite valve graft root replacement is a safe and reliable procedure for various aortic root diseases with stable early- and long-term results. The skirted technique seems to be attractive to avoid late graft detachment even in cases with a fragile inflammatory pathology.