Objectives We sought to compare the clinical profile and outcomes of operation s for aortic valve disease and ascending aortic aneurysm in patients treated wit h aortic valve replacement and supracoronary replacement ...Objectives We sought to compare the clinical profile and outcomes of operation s for aortic valve disease and ascending aortic aneurysm in patients treated wit h aortic valve replacement and supracoronary replacement of the ascending aorta or composite replacement of the aortic valve and ascending aorta (Bentall operat ion). Methods From 1990 through 2001, 133 patients had aortic valve replacement and supracoronary replacement of the ascending aorta, and 452 patients had Benta ll operations. Aortic valve replacement and supracoronary replacement of the asc ending aorta was performed in patients who had aortic valve disease and dilation of the ascending aorta, whereas the Bentall operation was performed in patients with aortic root abnormality and ascending aortic aneurysm. Mean follow up was 4.6±3.1 years and was 100%complete. Results Patients who had aortic valve rep lacement and supracoronary replacement of the ascending aorta were older (61±13 vs 52±16 years, P< .001) and more likely to have aortic stenosis, coronary art ery disease, and mitral valve disease than those who had Bentall operations. The use of mechanical valves was equal in both groups(42%for aortic valve replacem ent and supracoronary replacement of the ascending aorta and 43%for the Bentall operation). Operative mortality was 5%for patients underg oing aortic valve replacement and supracoronary replacement of the ascending aor ta and 4%for patients undergoing the Bentall operation (P=.45). Survival at 10 years was 57%±8%for patients undergoing aortic valve replacement and supracor onary replacement of the ascending aorta and 74%±4%for patients undergoing th e Bentall operation (P=.04), but the type of operation had no effect on survival . Older age, moderate or severe left ventricular dysfunction, active endocarditi s, previous cardiac surgery, and coronary artery disease were independent predic tors of death. The freedom from reoperation at 10 years was 95%±5%for patient s undergoing aortic valve replacement and supracoronary replacement of the ascen ding aorta and 94%±3%for patients undergoing the Bentall operation (P=.18). R eoperations were mostly because of tissue valve failure or endocarditis. The ris k of valve related complications was the same in both groups. No patient requir ed reoperation for aortic root aneurysm after having aortic valve replacement an d supracoronary replacement of the ascending aorta. Conclusions Aortic valve rep lacement and supracoronary replacement of the ascending aorta and the Bentall op eration provide comparable long term results. The Bentall operation is more app ropriate for patients with aortic root abnormality and a dilated ascending aorta , whereas aortic valve replacement and supracoronary replacement of the ascendin g aorta is a perfectly acceptable operation for patients with aortic valve disea se, normal or mildly dilated aortic sinuses, and a dilated ascending aorta.展开更多
Objectives: To examine the results of aortic valve sparing for aortic root aneurysm. Methods: Two hundred twenty consecutive patients who had aortic valve sparing for aortic root aneurysm were prospectively studied wi...Objectives: To examine the results of aortic valve sparing for aortic root aneurysm. Methods: Two hundred twenty consecutive patients who had aortic valve sparing for aortic root aneurysm were prospectively studied with annual clinical assessments and echocardiography. Their mean age was 46±15 years, 40%had Marfan syndrome, 17%had aortic dissection, and 7%had bicuspid aortic valve. Reimplantation of the aortic valve was performed in 167 patients and remodeling of the aortic root in 53. Aortic cusp repair was performed in 80 patients, and reinforcement of the free margin of one of the cusps with a fine polytetrafluoroethylene(Gore-Tex) suture in 48. The mean follow-up was 5.2±3.7 years and it was complete. Results: There were 3 operative and 13 late deaths. Patients’survival at 10 years was 88%±3%. Age older than 65 years, advanced functional class, and ejection fraction less than 40%were independent predictors of death. Moderate aortic insufficiency developed in 7 patients and severe insufficiency in 6. Freedom from moderate or severe aortic insufficiency at 10 years was 85%±5%for all patients, but it was 94%±4%after reimplantation and 75%±10%after remodeling(P=.04). Five patients required aortic valve replacement; the freedom from valve replacement at 10 years was 95%±3%. One case of endocarditis developed 11 years postoperatively. At the latest follow-up, 88%of the patients were in functional class I, and 10%were in class Ⅱ. Conclusions: Aortic valvesparing operation is associated with low rates of valve-related complications. The probability of late aortic insufficiency was lower after the reimplantation procedure than after remodeling in our experience.展开更多
文摘Objectives We sought to compare the clinical profile and outcomes of operation s for aortic valve disease and ascending aortic aneurysm in patients treated wit h aortic valve replacement and supracoronary replacement of the ascending aorta or composite replacement of the aortic valve and ascending aorta (Bentall operat ion). Methods From 1990 through 2001, 133 patients had aortic valve replacement and supracoronary replacement of the ascending aorta, and 452 patients had Benta ll operations. Aortic valve replacement and supracoronary replacement of the asc ending aorta was performed in patients who had aortic valve disease and dilation of the ascending aorta, whereas the Bentall operation was performed in patients with aortic root abnormality and ascending aortic aneurysm. Mean follow up was 4.6±3.1 years and was 100%complete. Results Patients who had aortic valve rep lacement and supracoronary replacement of the ascending aorta were older (61±13 vs 52±16 years, P< .001) and more likely to have aortic stenosis, coronary art ery disease, and mitral valve disease than those who had Bentall operations. The use of mechanical valves was equal in both groups(42%for aortic valve replacem ent and supracoronary replacement of the ascending aorta and 43%for the Bentall operation). Operative mortality was 5%for patients underg oing aortic valve replacement and supracoronary replacement of the ascending aor ta and 4%for patients undergoing the Bentall operation (P=.45). Survival at 10 years was 57%±8%for patients undergoing aortic valve replacement and supracor onary replacement of the ascending aorta and 74%±4%for patients undergoing th e Bentall operation (P=.04), but the type of operation had no effect on survival . Older age, moderate or severe left ventricular dysfunction, active endocarditi s, previous cardiac surgery, and coronary artery disease were independent predic tors of death. The freedom from reoperation at 10 years was 95%±5%for patient s undergoing aortic valve replacement and supracoronary replacement of the ascen ding aorta and 94%±3%for patients undergoing the Bentall operation (P=.18). R eoperations were mostly because of tissue valve failure or endocarditis. The ris k of valve related complications was the same in both groups. No patient requir ed reoperation for aortic root aneurysm after having aortic valve replacement an d supracoronary replacement of the ascending aorta. Conclusions Aortic valve rep lacement and supracoronary replacement of the ascending aorta and the Bentall op eration provide comparable long term results. The Bentall operation is more app ropriate for patients with aortic root abnormality and a dilated ascending aorta , whereas aortic valve replacement and supracoronary replacement of the ascendin g aorta is a perfectly acceptable operation for patients with aortic valve disea se, normal or mildly dilated aortic sinuses, and a dilated ascending aorta.
文摘Objectives: To examine the results of aortic valve sparing for aortic root aneurysm. Methods: Two hundred twenty consecutive patients who had aortic valve sparing for aortic root aneurysm were prospectively studied with annual clinical assessments and echocardiography. Their mean age was 46±15 years, 40%had Marfan syndrome, 17%had aortic dissection, and 7%had bicuspid aortic valve. Reimplantation of the aortic valve was performed in 167 patients and remodeling of the aortic root in 53. Aortic cusp repair was performed in 80 patients, and reinforcement of the free margin of one of the cusps with a fine polytetrafluoroethylene(Gore-Tex) suture in 48. The mean follow-up was 5.2±3.7 years and it was complete. Results: There were 3 operative and 13 late deaths. Patients’survival at 10 years was 88%±3%. Age older than 65 years, advanced functional class, and ejection fraction less than 40%were independent predictors of death. Moderate aortic insufficiency developed in 7 patients and severe insufficiency in 6. Freedom from moderate or severe aortic insufficiency at 10 years was 85%±5%for all patients, but it was 94%±4%after reimplantation and 75%±10%after remodeling(P=.04). Five patients required aortic valve replacement; the freedom from valve replacement at 10 years was 95%±3%. One case of endocarditis developed 11 years postoperatively. At the latest follow-up, 88%of the patients were in functional class I, and 10%were in class Ⅱ. Conclusions: Aortic valvesparing operation is associated with low rates of valve-related complications. The probability of late aortic insufficiency was lower after the reimplantation procedure than after remodeling in our experience.
