Management of aortic valve disease during aortic surgery

• Published in: The Annals of thoracic surgery Vol. 69; no. 3; pp. 778 - 783
• Main Authors: Svensson, Lars G, Longoria, James, Kimmel, Wendy A, Nadolny, Edward
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.03.2000
• Subjects: Adult; Aged; Aged, 80 and over; Aortic Valve - surgery; Cardiac Surgical Procedures - methods; Female; Follow-Up Studies; Heart Valve Diseases - mortality; Heart Valve Diseases - surgery; Humans; Male; Middle Aged; Postoperative Complications - epidemiology; Survival Rate
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(99)01415-0

Background. Alternative management strategies for aortic valve disease and aortic operation include valve preservation and aortic repair (VPR), composite valve graft (CVG), or separate valve and aortic repair (SVR). We evaluated these approaches. Methods. Of 250 ascending/arch operations, 151 patients had aortic valvular disease and dissection (n = 56, 37%) or aneurysms operated between November 1990 and January 1998. Sixty-seven patients underwent CVG insertion, 50 SVR, 13 VPR, and 21 only aortic repair alone (RA). Sixty (40%) patients also had aortic arch repairs and 53 (35%) coronary artery bypasses. Results. The early 30-day survival and stroke rates were 99% (150 of 151) and 0% (0 of 151), respectively: CVG 100% (67 of 67), 0%; VPR 100% (13 of 13), 0%; SVR 98% (49 of 50), 0%; RA 100% (21 of 21), 0% (p = not significant [NS]). On late follow-up of all patients (5 to 92 months; 96% complete 1998), 3 CVG, 2 VPR, 6 SVR, and 0 RA patients died with respective 5-year Kaplan-Meier survival rates of 88.4%, 70%, 69%, and 100% (p = 0.07, log-rank test). The respective linear rates for stroke were 0%, 5.5% (n = 1), 0%, and 0%; for hemorrhage were 0%, 0%, 0%, and 0%; and for endocarditis were 2.2% (n = 3), 0%, 0%, and 0% (p = NS). There were 11 late deaths and no patient required reoperation or ruptured the ascending aorta or the aortic arch. Conclusions. With careful selection of the appropriate method excellent early and late results can be achieved.