Composite graft in annulo-aortic ectasia. Nineteen years' experience without graft inclusion

OBJECTIVE: The original Bentall procedure for the surgery of annulo-aortic ectasia (AAE) includes the risk of leakage and pseudo-aneurysmformation in the coronary anastomosis. To avoid the complications mentionedabove we have used the open technique without the graft inclusion. In thisstudy we evaluate our early and late results. MATERIAL AND METHODS: Onehundred consecutive patients with annuloaortic ectasia underwent surgicalrepair with composite graft between December 1975 and February 1994. In allcases the aneurysmal tissue was radically resected and the origins of thecoronary arteries were directly reimplanted to the tube prosthesis. Nowrapping was used. Twenty-two patients met the clinical criteria of Marfansyndrome. Thirteen of the patients underwent an emergency operation,because of a rupture of aneurysm in 2 cases and an acute dissection in 11cases. Additional procedures were performed in 16 patients: mitral valvereplacement in 2, coronary artery bypass grafting in 12 patients and in 2cases the tube prosthesis included aortic arch, too. RESULTS: The overallhospital mortality was 3.0% (3/100). In the elective group there was onehospital death (1/87; 1.1%). In the emergency group two patients died inthe operation room (2/13; 16.7%). There have been 13 late deaths among the97 hospital survivors (13.4%). Four of the late deaths were surgeryrelated. Routine control angiography was performed in all patients 6 monthsafter surgery. Sixty patients who had lived at least 3 years after surgerywere called to reangiography and 53 of them came. No pseudo-aneurysm orleakage at distal anastomosis or coronary anastomosis could be seen. Aslight dilatation of one or both coronary origins was observed on 15patients; 9 of whom had Marfan syndrome. CONCLUSIONS: The open technique issimple and can be used in all anatomical variations of the annulo-aorticectasia. The early and late results are at least comparable with thoseachieved by other techniques.