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DOI: 10.1055/s-0032-1332433
Outcome after composite mechanical aortic root replacement: A consecutive series of 448 cases
Objectives: To determine the impact of different etiologies on the outcome and mortality after mechanical composite aortic root/ascending replacement.
Methods: From 02/1998 – 06/2011, 448 consecutive patients (pts. age: 53 ± 12yrs) underwent composite mechanical aortic root replacement: 80% for degenerative or atherosclerotic root/ascending aortic aneurysm (R/AsA = 362, age: 53 ± 12yrs), 15% for emergent acute type A aortic dissection (ADA = 65, age: 51 ± 13yrs) and 5% for acute infective endocarditis (AIE = 21, age: 47 ± 14yrs; native = 12, prosthetic = 9). Of all pts 15% (N = 68) had reoperative or redo procedures (age: 51 ± 11yrs).
Results: Overall hospital mortality after composite root/ascending replacement-including all emergencies regardless of etiology-was 6.7% (N = 30): 3.9% (N = 14) after elective/urgent aneurysm replacement, 20% (N = 13) after emergency repair for ADA and 14% for AIE (N = 3). Concomitant cardiac procedures were performed in 23%. Overall 1st year mortality-as a measure of operative success-was 5% (N = 19) for elective/urgent R/AsA repair, 21.5%(N = 14) after emergency repair for ADA and 14%(N = 3) after AIE (R/AsA vs. ADA, p = 0.03; R/AsA vs. AIE, p = 0.08; ADA vs. AIE, p = 0.8). Long-term survival after primary R/AsA replacement was 90.4% @5 years and 82.7% @10 years, with a linearized mortality rate after 30 days of 2.5%/patient-year (pt-yr). Long-term survival after surgery for ADA and AIE was 71% and 84.2% @5 years and 67.7% and 78.9% @10 years, with a linearized mortality rate of 2.6% and 3.7%/pt-y, respectively. Survival after composite root replacement after the 1st year parallels that of an age- and sex- matched population and is similar for the three compared etiologies, while women appear to have a less favorable longevity.
Conclusions: Composite root replacement remains a versatile choice for various pathologies with excellent longevity and freedom from reoperation and should be strongly considered if conditions for valve-sparing repair are less than perfect.
Fig. 1: Longevity1