Long-term fate of the aortic root and aortic valve after ascending aneurysm surgery

Objective: The authors determined in which patients tube graft replacement could be used. Summary Background Data: Tube graft replacement of ascending aortic aneurysms requires no coronary anastomoses and preserves the native aortic valve, but aortic insufficiency or aortic root aneurysms may develop requiring reoperation. Use of Bentall or Cabrol composite valve graft procedures obviates these problems but requires prosthetic valve replacement and coronary reattachment, both of which are associated with complications. These two procedures have been applied increasingly but because of renewed interest in aortic valve preservation and reconstruction, the authors determined in which patients tube replacement could be used. Methods: The authors analyzed the fate of 277 patients, mean age 49 ± 14 years, operated on between 1953 and 1992 by techniques that preserved the aortic root. The most common pathology was atherosclerosis in 104 patients. Perioperative mortality since 1975 was 14%. Results: Fifteen patients required reoperation on the ascending aorta or aortic root: ascending aneurysm reoperation (6 patients); aortic valve replacement (8 patients), and a combined procedure (1 patient). Of these 15 patients, 8 had Marfan's syndrome, 10 had dissections, and 5 had medial degeneration/necrosis. Conclusions: Simple tube graft replacement of the ascending aorta was a durable technique in patients without Marfans syndrome or medial degeneration/necrosis and allowed preservation of the native aortic valve in many patients.