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
The optimal diameter at which replacement of the ascending aorta should be per formed in patients with bicuspid aortic valve disease is not known. We reviewed all patients with bicuspid aortic valves undergoing aortic...The optimal diameter at which replacement of the ascending aorta should be per formed in patients with bicuspid aortic valve disease is not known. We reviewed all patients with bicuspid aortic valves undergoing aortic valve replacement at our institution from 1979 through 1993(n=201). Patients undergoing concomitant r eplacement of the ascending aorta were excluded. Follow-up was obtained on 98% of patients and was 10.3 3.8(mean SD) years. The average patient age was 56 15 y ears, and 76%were male. The ascending aorta was normal(4.0 cm) in 115(57%) pat ients, mildly dilated(4.0-4.4 cm) in 64(32%) patients, and moderately dilated( 4.5-4.9 cm) in 22 (11%) patients. All patients with bicuspid aortic valves wit h marked dilation(5.0 cm) underwent replacement of the ascending aorta and were therefore excluded. Fifteen-year survival was 67%. During follow-up, 44 patie nts required reoperation, predominantly for aortic valve prosthesis failure. Twe nty-two patients had long-term complications related to the ascending aorta: 1 8 required an operative procedure to replace the ascending aorta(for aortic aneu rysm), 1 had aortic dissection, and 3 experienced sudden cardiac death. Fifteen -year freedom from ascending aortarelated complications was 86%, 81%, and 43 %in patients with an aortic diameter of less than 4.0 cm, 4.0 to 4.4 cm, and 4. 5 to 4.9 cm, respectively(P . 001). Patients undergoing operations for bicuspid aortic valve disease should be considered for concomitant replacement of the asc ending aorta if the diameter is 4.5 cm or greater.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The optimal diameter at which replacement of the ascending aorta should be per formed in patients with bicuspid aortic valve disease is not known. We reviewed all patients with bicuspid aortic valves undergoing aortic valve replacement at our institution from 1979 through 1993(n=201). Patients undergoing concomitant r eplacement of the ascending aorta were excluded. Follow-up was obtained on 98% of patients and was 10.3 3.8(mean SD) years. The average patient age was 56 15 y ears, and 76%were male. The ascending aorta was normal(4.0 cm) in 115(57%) pat ients, mildly dilated(4.0-4.4 cm) in 64(32%) patients, and moderately dilated( 4.5-4.9 cm) in 22 (11%) patients. All patients with bicuspid aortic valves wit h marked dilation(5.0 cm) underwent replacement of the ascending aorta and were therefore excluded. Fifteen-year survival was 67%. During follow-up, 44 patie nts required reoperation, predominantly for aortic valve prosthesis failure. Twe nty-two patients had long-term complications related to the ascending aorta: 1 8 required an operative procedure to replace the ascending aorta(for aortic aneu rysm), 1 had aortic dissection, and 3 experienced sudden cardiac death. Fifteen -year freedom from ascending aortarelated complications was 86%, 81%, and 43 %in patients with an aortic diameter of less than 4.0 cm, 4.0 to 4.4 cm, and 4. 5 to 4.9 cm, respectively(P . 001). Patients undergoing operations for bicuspid aortic valve disease should be considered for concomitant replacement of the asc ending aorta if the diameter is 4.5 cm or greater.
