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Original Articles: Adult Cardiac

Long-Term Results of Aortic Root Replacement: 15 Years' Experience

Ilker Mataraci, MD^a,_*, Adil Polat, MD^b, Burak Kran, MD^c, Ahmet Calkan, MD^a, Altug Tuncer, MD^a, Vedat Erentug, MD^d, Kaan Kirali, MD^a, Omer Isik, MD^e, Cevat Yakut, MD^a

^a Kartal Kosuyolu Heart and Research Hospital, Cardiovascular Surgery Clinic, Istanbul, Turkey
^d Bagcilar Research and Training Hospital, Istanbul, Turkey
^e JFK Hospital, Istanbul, Turkey
^b Military Hospital, Elazig, Turkey
^c Elazig Research and Training Hospital, Elazig, Turkey

Accepted for publication March 17, 2009.

^_* Address correspondence to Dr Mataraci, Kartal Kosuyolu Heart and Research Hospital, Cardiovascular Surgery Clinic, Istanbul, Turkey (Email: adilpol{at}yahoo.com).

Background: Long-term results of aortic root replacements and the factors affecting long-term mortality were analyzed.

Methods: We operated on 254 patients from June 1993 to November 2008 for aortic root replacement with Bentall de Bono procedure. Two hundred five patients were male (80.7%) and 49 patients (19.3%) were female. The mean age was 48.3 ± 14.7 years (range, 14 to 78 years). We performed 72 concomitant procedures in 69 patients, and the most commonly performed procedure was coronary artery bypass grafting in 37 patients (14.6%). The most common indication for aortic root replacement was aneurysm in 235 patients (92.5%). Thirty-four patients (13.4%) had Marfan syndrome. Hypothermic circulatory arrest was used in 52 patients (20.5%). After removing the clamp, we had to reclamp the aorta in 26 patients (10.2%) undergoing operation.

Results: Postoperatively 30 patients (11.8%) had in-hospital mortality. The late mortality was 2.8% (7 patients). The most common reason for hospital mortality was low cardiac output (18 in 30 patients; 51.4%). Neurologic complications were seen in 16 patients (6.3%). The mean duration of hospital stay was 16.6 ± 11.3 days (range, 5 to 77 days). Postoperative follow-up was 6.3 ± 4.5 years (range, 0 to 15.5 years) on average. Late mortality was significantly affected by Marfan syndrome (p = 0.025) and reclamping the aorta (p = 0.036). Actuarial survival for the overall 254 patients is 88.4% ± 2.1%, 87.4% ± 2.2%, and 84.5% ± 2.56% at 1, 3, and 10 years, respectively.

Conclusions: The late-term results of aortic root replacement with the modified Bentall de Bono procedure are satisfactory. Survival is decreased in patients with Marfan syndrome and in the patients who had reclamping intraoperatively.

This article has been cited by other articles:

				A. Polat, E. B. Polat, and V. Erentug External aortic root support for Marfan syndrome J R Soc Med, December 1, 2010; 103(12): 479 - 479. [Full Text] [PDF]

				T. Treasure and J. Pepper Reply to Polat and colleagues. J R Soc Med, December 1, 2010; 103(12): 479 - 479. [Full Text] [PDF]

				A. Polat, I. Uyar, and I. Mataraci A Modified Composite Graft for Prevention of Postoperative Bleeding From the Proximal Anastomosis Ann. Thorac. Surg., August 1, 2010; 90(2): 699 - 700. [Full Text] [PDF]