Graft Replacement of Ascending Aortic Aneurysms. Surgical Results in 84 Consecutive Patients

Abstract

Between January, 1977, and March, 1990, 84 consecutive patients underwent graft replacement of an ascending aortic aneurysm. There were 22 women and 62 men patients, ranging in age from twenty-two to sixty-nine years (mean 44.3). Surgical procedures employed were as follows: composite graft replacement with coronary reimplantation in 53 cases, supracoronary graft replacement (SGR) in 23 cases, SGR + aortic resuspension in 2 cases, and SGR + aortic valve replace ment in 1 case. Twenty-eight patients (33%) underwent concomitant aortic arch replacement. Five cases were operated on by "elephant-trunk" technique for extensive aneurysms involving the ascending, arch, and descending thoracic aorta. In 71 cases, a shunt was inserted between the periprosthetic space and the right atrium.

Hospital (thirty-day) mortality was 15.5%. Contemporary (1987-1990) mortality rate was 8.7%. After a mean follow-up period of 42.6 months (range three to one hundred eighteen), there were 2 late deaths (1.1%/patient-year). Late reoperation was necessary in 2 cases (1.1%/patient-year). Ninety-one per cent of the survivors were in NYHA class I or II. The long-term survival rate was 76% ± 12%. The type of operation (ie, composite graft replacement or SGR) or concomitant aortic arch replacement had no influence on surgical outcome. The periprosthetic right atrial shunt was found to be effective in avoid ing complications related to blood accumulating between the aortic graft and the aortic wraparound.

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References

Bentall HH , DeBono A. : A technique for complete replacement of the ascending aorta. Thorax 23:338-339, 1968.

Bloodwell RD , Hallman GL , Colley DA : Aneurysm of the ascending aorta with aortic valvular insufficiency. Arch Surg 92:588-599, 1965.

Cabrol C. , Pavie A. , Mesnildrey P. , et al: Long-term results with total replacement of the ascending aorta and reimplantation of the coronary arteries. J Thoac Cardiovasc Surg 91:17-25, 1986.

Groves LK , Effler DB , Hawk WA , et al: Aortic insufficiency secondary to aneurysmal changes in the ascending aorta. Surgical management. J Thorac Cardiovasc Surg 48:362-379, 1964.

Wheat MWJr , Wilson JR , Bartley TD : Successful replacement of the entire ascending aorta and aortic valve. JAMA 188:717-719, 1964.

Borst HG : Replacing the ascending aorta and aortic valve. Ann Thorac Surg 32:613-614, 1981.

Kouchoukos NT , Marshall WGJr , Wedige-Stecher TA : Eleven-year experience with composite graft replacement of the ascending aorta and aortic valve. J Thorac Cardiovasc Surg 92:691-705, 1986.

McCready RA , Pluth JR : Surgical treatment of ascending aortic aneurysms associated with aortic valve insufficiency. Ann Thorac Surg 28:307-316, 1979.

Miller DC , Stinson EB , Oyer PE , et al: Concomitant resection of ascending aortic aneurysm and replacement of the aortic valve. Operative and long-term results with "conventional" techniques in ninety patients. J Thorac Cardiovasc Surg 79: 388-401, 1980.

10.

Najafi H. , Dye WS , Javid H. , et al: Aortic insufficiency secondary to aortic root aneurysm or dissection . Arch Surg 110:1401-1407, 1975 .

11.

Yokoyama M. : A new coronary tube for Cabrol's technique . J Thorac Cardiovasc Surg 95:738-739, 1988.

12.

Borat HG , Walterbusch G. , Schaps D. : Extensive aortic replacement using "elephant-trunk" prosthesis. Thorac Cardiovasc Surg 31:37-40, 1983.

13.

Borst HG , Frank G. , Schaps D. : Treatment of extensive aortic aneurysms by a new multiple-stage approach . J Thorac Cardiovasc Surg 95:11-13, 1988.

14.

Grey DP , Ott DA , Cooley DA : Surgical treatment of aneurysm of the ascending aorta with aortic insufficiency . J Thorac Cardiovasc Surg 86:864-877, 1983.

15.

Mayer JEJr , Lindsay WG , Wang Y. , et al: Composite replacement of the aortic valve and ascending aorta. J Thorac Cardiovasc Surg 76:816-823, 1978.

16.

Crosby IK , Ashcraft WC , Reed WA : Surgery of proximal aorta in Marfan's syndrome. J Thorac Cardiovasc Surg 66:75-81. 1973.

17.

Klopp E. , Hauer J. , Zinner M. , et al: Acute supravalvular stenosis following replacement of the aortic valve and ascending aorta in a patient with Marfan's syndrome: Report of a case. Surgery 84:292-294, 1978.

18.

Marvasti MA , Parker FBJr , Randall PA , et al: Composite graft replacement of the ascending aorta and aortic valve. Late follow-up with intra-arterial digital subtraction angiography . J Thorac Cardiovasc Surg 95:924-928, 1988.

19.

Crawford ES , Coselli JS : Marfan's syndrome: Combined composite valve graft replacement of the aortic root and transaortic mitral replacement. Ann Thorac Surg 45:296-302, 1988.

20.

Kouchoukos NT : Inclusion (aneurysm wrap) technique for composite graft replacement of the ascending aorta and aortic valve. J Thorac Cardiovasc Surg 96:967, 1988.

21.

Carpentier A. , Delocje A. , Fabiani JN , et al: New surgical approach to aortic dissection: Flow reversal and thromboexclusion. J Thorac Cardiovasc Surg 81:659-668, 1981.

22.

Odagiri S. , Shimazu A. , Sjimokawaji M. , et al: Use of a new stapling instrument for permanent occlusion of the aorta in the surgical procedure for thromboexclusion. Ann Thorac Surg 47:466-469, 1989.

23.

Zubiate P. , Kay JH : Surgical treatment of aneuurysm of the ascending aorta with aortic insufficiency and marked displacement of the coronary ostia. J Thorac Cardiovasc Surg 71:415-421, 1976.

24.

Mestres CA , Betriu A. , Pomar JL : Occlusion of the coronary perfusion graft: An exceptional complication after reconstruction of the ascending aorta with the Cabrol technique. J Thorac Cardiovasc Surg 98:302-303, 1989.

25.

Ross DN , Frazier TT , Gonzales-Lavin L. : Surgery of Marfan's syndrome and related conditions of the aortic root (annulo-aortic ectasia). Thorax 27:52-57, 1972.

26.

Symbas TN , Raizner AE , Tyras DH , et al: Aneurysms of all sinuses of Valsalva in patients with Marfan's syndrome. Ann Surg 174:902-907, 1971,

27.

Helseth HK , Haglin JJ , Monson BK , et al: Results of composite graft replacement for aortic root aneurysm . J Thorac Cardiovasc Surg 80:754-759, 1980.

28.

Donaldson RM , Ross DN : Composite graft replacement for the treatment of aneurysms of the ascending aorta associated with aortic valvular disease . Circulation 66 (Suppl I):116-121, 1982.

29.

Gott VL , Pyeritz RE , Magovern GJ , et al: Surgical treatment of aneurysms of the ascending aorta in the Marfan syndrome. Results of composite-graft repair in 50 patients. N Engl Med 314:1070-1074, 1986 .

30.

Jex RK , Schaff RV , Piehler JM , et al: Repair of ascending aortic dissection. Influence of associated aortic valve insufficiency on early and late results. J Thorac Cardiovasc Surg 93:375-384, 1987.

31.

Olinger GN , Schweiger JA , Galbraith TA : Primary repair of acute ascending aortic dissection. Ann Thorac Surg 44:389-393, 1987.

32.

Crawford ES : Marfan's syndrome. Broad spectral surgical treatment cardiovascular manifestations. Ann Surg 198:487-505, 1983.

33.

Haverich A. , Miller DC , Scott WC , et al: Acute and chronic aortic dissections: Determinants of long term outcome for operative survivors . Circulation 72 (Pt 2):22-34, 1985 .