Long-term survival, valve durability, and reoperation for 4 aortic root procedures combined with ascending aorta replacement

Abstract Objective To evaluate long-term results of aortic root procedures combined with ascending aorta replacement for aneurysms, using 4 surgical strategies. Methods From January 1995 to January 2011, 957 patients underwent 1 of 4 aortic root procedures: valve preservation (remodeling or modified...

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Veröffentlicht in:	The Journal of thoracic and cardiovascular surgery 2016-03, Vol.151 (3), p.764-774.e4
Hauptverfasser:	Svensson, Lars G., MD, PhD, Pillai, Saila T., MD, MPH, Rajeswaran, Jeevanantham, PhD, Desai, Milind Y., MD, Griffin, Brian, MD, Grimm, Richard, DO, Hammer, Donald F., MD, Thamilarasan, Maran, MD, Roselli, Eric E., MD, Pettersson, Gösta B., MD, PhD, Gillinov, A. Marc, MD, Navia, Jose L., MD, Smedira, Nicholas G., MD, Sabik, Joseph F., MD, Lytle, Bruce W., MD, Blackstone, Eugene H., MD
Format:	Artikel
Sprache:	eng
Schlagworte:	Age Factors Allografts aorta Aortic Aneurysm - diagnosis Aortic Aneurysm - mortality Aortic Aneurysm - surgery aortic valve Aortic Valve - physiopathology Aortic Valve - transplantation Bioprosthesis Blood Vessel Prosthesis Blood Vessel Prosthesis Implantation - adverse effects Blood Vessel Prosthesis Implantation - instrumentation Blood Vessel Prosthesis Implantation - mortality Cardiothoracic Surgery Heart Valve Prosthesis Heart Valve Prosthesis Implantation - adverse effects Heart Valve Prosthesis Implantation - instrumentation Heart Valve Prosthesis Implantation - mortality Hospital Mortality Humans Patient Selection Postoperative Complications - mortality Postoperative Complications - surgery Prosthesis Design Registries Reoperation Replantation Risk Assessment Risk Factors root root sparing Time Factors Treatment Outcome valve preservation
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Zusammenfassung:	Abstract Objective To evaluate long-term results of aortic root procedures combined with ascending aorta replacement for aneurysms, using 4 surgical strategies. Methods From January 1995 to January 2011, 957 patients underwent 1 of 4 aortic root procedures: valve preservation (remodeling or modified reimplantation, n = 261); composite biologic graft (n = 297); composite mechanical graft (n = 156); or allograft root (n = 243). Results Seven deaths occurred (0.73%), none after valve-preserving procedures, and 13 strokes (1.4%). Composite grafts exhibited higher gradients than allografts or valve preservation, but the latter 2 exhibited more aortic regurgitation (2.7% biologic and 0% mechanical composite grafts vs 24% valve-preserving and 19% allografts at 10 years). Within 2 to 5 years, valve preservation exhibited the least left ventricular hypertrophy, allograft replacement the greatest; however, valve preservation had the highest early risk of reoperation, allograft replacement the lowest. Patients receiving allografts had the highest risk of late reoperation ( P
ISSN:	0022-5223 1097-685X
DOI:	10.1016/j.jtcvs.2015.10.113