Surgery for aneurysms of the aortic root: a 30-year experience
This study evaluated long-term results of aortic root replacement and valve-preserving aortic root reconstruction for patients with aneurysms involving the aortic root. Two-hundred three patients aged 53+/-16 years (mean+/-SD; 153 male, 50 female) underwent elective or urgent aortic root surgery fro...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2004-09, Vol.110 (11), p.1364-1371 |
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| creator | Zehr, Kenton J Orszulak, Thomas A Mullany, Charles J Matloobi, Alireza Daly, Richard C Dearani, Joseph A Sundt, 3rd, Thoralf M Puga, Francisco J Danielson, Gordon K Schaff, Hartzell V |
| description | This study evaluated long-term results of aortic root replacement and valve-preserving aortic root reconstruction for patients with aneurysms involving the aortic root.
Two-hundred three patients aged 53+/-16 years (mean+/-SD; 153 male, 50 female) underwent elective or urgent aortic root surgery from 1971 to 2000 for an aortic root aneurysm: 149 patients underwent a composite valve conduit reconstruction, and 54 patients underwent valve-preserving aortic root reconstruction. Fifty patients had Marfan syndrome. In-hospital and 30-day mortality was 4.0% (8/203) overall: for a composite valve conduit procedure, the corresponding value was 4.0% (6/149) and for valve-preserving procedure, 3.7% (2/54) (P=NS). Morbidity included 3 strokes (1%), 10 perioperative myocardial infarctions (5%), and 8 reoperations for bleeding (4%). Actuarial survival at 5, 10, 15, and 20 years was 93% (95% confidence interval [CI] = 88% to 97%), 79% (95% CI = 71% to 87%), 67% (95% CI = 57% to 79%), and 52% (95% CI = 36% to 69%), respectively. Freedom from reoperation was 72% (95% CI = 54% to 86%) at 20 years. Complications with anticoagulation occurred in 29 patients; with valve thrombosis, in 2; and with hemorrhage, in 27 (4 life threatening and 23 minor). Freedom from thromboembolism was 91% (95% CI = 77% to 98%) at 20 years. Freedom from endocarditis was 99% (95% CI = 92% to 100%) at 20 years. Multivariate analysis revealed preoperative mitral valve regurgitation (+3 to 4) and older age to be significant predictors of late death (P< or =0.005), and Marfan syndrome, initial valve-preserving aortic root reconstruction, and need for a concomitant procedure at initial operation to be significant predictors of the need for reoperation (P< or =0.01).
Aortic root replacement for aortic root aneurysms can be done with low morbidity and mortality. Composite valve conduit reconstruction resulted in a durable result. There were few serious complications related to the need for long-term anticoagulation or a prosthetic valve. Reoperation was most commonly required because of failure of the aortic valve when a valve-preserving aortic root reconstruction was performed or for other cardiac or aortic disease elsewhere. |
| doi_str_mv | 10.1161/01.CIR.0000141593.05085.87 |
| format | Article |
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Two-hundred three patients aged 53+/-16 years (mean+/-SD; 153 male, 50 female) underwent elective or urgent aortic root surgery from 1971 to 2000 for an aortic root aneurysm: 149 patients underwent a composite valve conduit reconstruction, and 54 patients underwent valve-preserving aortic root reconstruction. Fifty patients had Marfan syndrome. In-hospital and 30-day mortality was 4.0% (8/203) overall: for a composite valve conduit procedure, the corresponding value was 4.0% (6/149) and for valve-preserving procedure, 3.7% (2/54) (P=NS). Morbidity included 3 strokes (1%), 10 perioperative myocardial infarctions (5%), and 8 reoperations for bleeding (4%). Actuarial survival at 5, 10, 15, and 20 years was 93% (95% confidence interval [CI] = 88% to 97%), 79% (95% CI = 71% to 87%), 67% (95% CI = 57% to 79%), and 52% (95% CI = 36% to 69%), respectively. Freedom from reoperation was 72% (95% CI = 54% to 86%) at 20 years. Complications with anticoagulation occurred in 29 patients; with valve thrombosis, in 2; and with hemorrhage, in 27 (4 life threatening and 23 minor). Freedom from thromboembolism was 91% (95% CI = 77% to 98%) at 20 years. Freedom from endocarditis was 99% (95% CI = 92% to 100%) at 20 years. Multivariate analysis revealed preoperative mitral valve regurgitation (+3 to 4) and older age to be significant predictors of late death (P< or =0.005), and Marfan syndrome, initial valve-preserving aortic root reconstruction, and need for a concomitant procedure at initial operation to be significant predictors of the need for reoperation (P< or =0.01).
Aortic root replacement for aortic root aneurysms can be done with low morbidity and mortality. Composite valve conduit reconstruction resulted in a durable result. There were few serious complications related to the need for long-term anticoagulation or a prosthetic valve. Reoperation was most commonly required because of failure of the aortic valve when a valve-preserving aortic root reconstruction was performed or for other cardiac or aortic disease elsewhere.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/01.CIR.0000141593.05085.87</identifier><identifier>PMID: 15313937</identifier><language>eng</language><publisher>United States</publisher><subject>Adult ; Aged ; Anticoagulants - adverse effects ; Anticoagulants - therapeutic use ; Aorta - surgery ; Aortic Aneurysm - etiology ; Aortic Aneurysm - surgery ; Disease-Free Survival ; Endocarditis - epidemiology ; Female ; Hospital Mortality ; Humans ; Length of Stay - statistics & numerical data ; Life Tables ; Male ; Marfan Syndrome - complications ; Middle Aged ; Mitral Valve Insufficiency - complications ; Myocardial Infarction - epidemiology ; Postoperative Complications - epidemiology ; Postoperative Hemorrhage - epidemiology ; Proportional Hazards Models ; Reoperation ; Retrospective Studies ; Sinus of Valsalva - surgery ; Stroke - epidemiology ; Survival Analysis ; Survival Rate ; Thromboembolism - epidemiology</subject><ispartof>Circulation (New York, N.Y.), 2004-09, Vol.110 (11), p.1364-1371</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c358t-8caec52443a269b89457f87a5c0c1e0faabe570043ad444ae42b36bb0437b2263</citedby><cites>FETCH-LOGICAL-c358t-8caec52443a269b89457f87a5c0c1e0faabe570043ad444ae42b36bb0437b2263</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,3687,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15313937$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zehr, Kenton J</creatorcontrib><creatorcontrib>Orszulak, Thomas A</creatorcontrib><creatorcontrib>Mullany, Charles J</creatorcontrib><creatorcontrib>Matloobi, Alireza</creatorcontrib><creatorcontrib>Daly, Richard C</creatorcontrib><creatorcontrib>Dearani, Joseph A</creatorcontrib><creatorcontrib>Sundt, 3rd, Thoralf M</creatorcontrib><creatorcontrib>Puga, Francisco J</creatorcontrib><creatorcontrib>Danielson, Gordon K</creatorcontrib><creatorcontrib>Schaff, Hartzell V</creatorcontrib><title>Surgery for aneurysms of the aortic root: a 30-year experience</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>This study evaluated long-term results of aortic root replacement and valve-preserving aortic root reconstruction for patients with aneurysms involving the aortic root.
Two-hundred three patients aged 53+/-16 years (mean+/-SD; 153 male, 50 female) underwent elective or urgent aortic root surgery from 1971 to 2000 for an aortic root aneurysm: 149 patients underwent a composite valve conduit reconstruction, and 54 patients underwent valve-preserving aortic root reconstruction. Fifty patients had Marfan syndrome. In-hospital and 30-day mortality was 4.0% (8/203) overall: for a composite valve conduit procedure, the corresponding value was 4.0% (6/149) and for valve-preserving procedure, 3.7% (2/54) (P=NS). Morbidity included 3 strokes (1%), 10 perioperative myocardial infarctions (5%), and 8 reoperations for bleeding (4%). Actuarial survival at 5, 10, 15, and 20 years was 93% (95% confidence interval [CI] = 88% to 97%), 79% (95% CI = 71% to 87%), 67% (95% CI = 57% to 79%), and 52% (95% CI = 36% to 69%), respectively. Freedom from reoperation was 72% (95% CI = 54% to 86%) at 20 years. Complications with anticoagulation occurred in 29 patients; with valve thrombosis, in 2; and with hemorrhage, in 27 (4 life threatening and 23 minor). Freedom from thromboembolism was 91% (95% CI = 77% to 98%) at 20 years. Freedom from endocarditis was 99% (95% CI = 92% to 100%) at 20 years. Multivariate analysis revealed preoperative mitral valve regurgitation (+3 to 4) and older age to be significant predictors of late death (P< or =0.005), and Marfan syndrome, initial valve-preserving aortic root reconstruction, and need for a concomitant procedure at initial operation to be significant predictors of the need for reoperation (P< or =0.01).
Aortic root replacement for aortic root aneurysms can be done with low morbidity and mortality. Composite valve conduit reconstruction resulted in a durable result. There were few serious complications related to the need for long-term anticoagulation or a prosthetic valve. Reoperation was most commonly required because of failure of the aortic valve when a valve-preserving aortic root reconstruction was performed or for other cardiac or aortic disease elsewhere.</description><subject>Adult</subject><subject>Aged</subject><subject>Anticoagulants - adverse effects</subject><subject>Anticoagulants - therapeutic use</subject><subject>Aorta - surgery</subject><subject>Aortic Aneurysm - etiology</subject><subject>Aortic Aneurysm - surgery</subject><subject>Disease-Free Survival</subject><subject>Endocarditis - epidemiology</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Length of Stay - statistics & numerical data</subject><subject>Life Tables</subject><subject>Male</subject><subject>Marfan Syndrome - complications</subject><subject>Middle Aged</subject><subject>Mitral Valve Insufficiency - complications</subject><subject>Myocardial Infarction - epidemiology</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Hemorrhage - epidemiology</subject><subject>Proportional Hazards Models</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Sinus of Valsalva - surgery</subject><subject>Stroke - epidemiology</subject><subject>Survival Analysis</subject><subject>Survival Rate</subject><subject>Thromboembolism - epidemiology</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkNtKAzEQhoMotlZfQYIX3u2a4ybbC0GKh0JB8HAdsumsrnSbmuxC9-1NbaFzM8zMPzM_H0I3lOSUFvSO0Hw2f8tJCiqoLHlOJNEy1-oEjalkIhOSl6donARlpjhjI3QR408qC67kORpRySkvuRqj-_c-fEEYcO0DtmvowxDbiH2Nu2_A1oeucTh4302xxZxkA9iAYbuB0MDawSU6q-0qwtUhT9Dn0-PH7CVbvD7PZw-LzHGpu0w7Cy4ZE9yyoqx0KaSqtbLSEUeB1NZWIBUhab4UQlgQrOJFVaWGqhgr-ATd7u9ugv_tIXambaKD1SpZ9n00RaHVjkUSTvdCF3yMAWqzCU1rw2AoMTt6hlCT6JkjPfNPz2iVlq8PX_qqheVx9YCL_wENq2oT</recordid><startdate>20040914</startdate><enddate>20040914</enddate><creator>Zehr, Kenton J</creator><creator>Orszulak, Thomas A</creator><creator>Mullany, Charles J</creator><creator>Matloobi, Alireza</creator><creator>Daly, Richard C</creator><creator>Dearani, Joseph A</creator><creator>Sundt, 3rd, Thoralf M</creator><creator>Puga, Francisco J</creator><creator>Danielson, Gordon K</creator><creator>Schaff, Hartzell V</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20040914</creationdate><title>Surgery for aneurysms of the aortic root: a 30-year experience</title><author>Zehr, Kenton J ; Orszulak, Thomas A ; Mullany, Charles J ; Matloobi, Alireza ; Daly, Richard C ; Dearani, Joseph A ; Sundt, 3rd, Thoralf M ; Puga, Francisco J ; Danielson, Gordon K ; Schaff, Hartzell V</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c358t-8caec52443a269b89457f87a5c0c1e0faabe570043ad444ae42b36bb0437b2263</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anticoagulants - adverse effects</topic><topic>Anticoagulants - therapeutic use</topic><topic>Aorta - surgery</topic><topic>Aortic Aneurysm - etiology</topic><topic>Aortic Aneurysm - surgery</topic><topic>Disease-Free Survival</topic><topic>Endocarditis - epidemiology</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Length of Stay - statistics & numerical data</topic><topic>Life Tables</topic><topic>Male</topic><topic>Marfan Syndrome - complications</topic><topic>Middle Aged</topic><topic>Mitral Valve Insufficiency - complications</topic><topic>Myocardial Infarction - epidemiology</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Hemorrhage - epidemiology</topic><topic>Proportional Hazards Models</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Sinus of Valsalva - surgery</topic><topic>Stroke - epidemiology</topic><topic>Survival Analysis</topic><topic>Survival Rate</topic><topic>Thromboembolism - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zehr, Kenton J</creatorcontrib><creatorcontrib>Orszulak, Thomas A</creatorcontrib><creatorcontrib>Mullany, Charles J</creatorcontrib><creatorcontrib>Matloobi, Alireza</creatorcontrib><creatorcontrib>Daly, Richard C</creatorcontrib><creatorcontrib>Dearani, Joseph A</creatorcontrib><creatorcontrib>Sundt, 3rd, Thoralf M</creatorcontrib><creatorcontrib>Puga, Francisco J</creatorcontrib><creatorcontrib>Danielson, Gordon K</creatorcontrib><creatorcontrib>Schaff, Hartzell V</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zehr, Kenton J</au><au>Orszulak, Thomas A</au><au>Mullany, Charles J</au><au>Matloobi, Alireza</au><au>Daly, Richard C</au><au>Dearani, Joseph A</au><au>Sundt, 3rd, Thoralf M</au><au>Puga, Francisco J</au><au>Danielson, Gordon K</au><au>Schaff, Hartzell V</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Surgery for aneurysms of the aortic root: a 30-year experience</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2004-09-14</date><risdate>2004</risdate><volume>110</volume><issue>11</issue><spage>1364</spage><epage>1371</epage><pages>1364-1371</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><abstract>This study evaluated long-term results of aortic root replacement and valve-preserving aortic root reconstruction for patients with aneurysms involving the aortic root.
Two-hundred three patients aged 53+/-16 years (mean+/-SD; 153 male, 50 female) underwent elective or urgent aortic root surgery from 1971 to 2000 for an aortic root aneurysm: 149 patients underwent a composite valve conduit reconstruction, and 54 patients underwent valve-preserving aortic root reconstruction. Fifty patients had Marfan syndrome. In-hospital and 30-day mortality was 4.0% (8/203) overall: for a composite valve conduit procedure, the corresponding value was 4.0% (6/149) and for valve-preserving procedure, 3.7% (2/54) (P=NS). Morbidity included 3 strokes (1%), 10 perioperative myocardial infarctions (5%), and 8 reoperations for bleeding (4%). Actuarial survival at 5, 10, 15, and 20 years was 93% (95% confidence interval [CI] = 88% to 97%), 79% (95% CI = 71% to 87%), 67% (95% CI = 57% to 79%), and 52% (95% CI = 36% to 69%), respectively. Freedom from reoperation was 72% (95% CI = 54% to 86%) at 20 years. Complications with anticoagulation occurred in 29 patients; with valve thrombosis, in 2; and with hemorrhage, in 27 (4 life threatening and 23 minor). Freedom from thromboembolism was 91% (95% CI = 77% to 98%) at 20 years. Freedom from endocarditis was 99% (95% CI = 92% to 100%) at 20 years. Multivariate analysis revealed preoperative mitral valve regurgitation (+3 to 4) and older age to be significant predictors of late death (P< or =0.005), and Marfan syndrome, initial valve-preserving aortic root reconstruction, and need for a concomitant procedure at initial operation to be significant predictors of the need for reoperation (P< or =0.01).
Aortic root replacement for aortic root aneurysms can be done with low morbidity and mortality. Composite valve conduit reconstruction resulted in a durable result. There were few serious complications related to the need for long-term anticoagulation or a prosthetic valve. Reoperation was most commonly required because of failure of the aortic valve when a valve-preserving aortic root reconstruction was performed or for other cardiac or aortic disease elsewhere.</abstract><cop>United States</cop><pmid>15313937</pmid><doi>10.1161/01.CIR.0000141593.05085.87</doi><tpages>8</tpages></addata></record> |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Complete |
| subjects | Adult Aged Anticoagulants - adverse effects Anticoagulants - therapeutic use Aorta - surgery Aortic Aneurysm - etiology Aortic Aneurysm - surgery Disease-Free Survival Endocarditis - epidemiology Female Hospital Mortality Humans Length of Stay - statistics & numerical data Life Tables Male Marfan Syndrome - complications Middle Aged Mitral Valve Insufficiency - complications Myocardial Infarction - epidemiology Postoperative Complications - epidemiology Postoperative Hemorrhage - epidemiology Proportional Hazards Models Reoperation Retrospective Studies Sinus of Valsalva - surgery Stroke - epidemiology Survival Analysis Survival Rate Thromboembolism - epidemiology |
| title | Surgery for aneurysms of the aortic root: a 30-year experience |
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