Aortic root replacement

OBJECTIVE: To report our operative experience with aortic root replacement in 231 patients with aortic root aneurysm and discuss the current indications, methods, and surgical techniques. METHODS: Between January 1994 and August 1999, a group of 231 consecutive patients underwent aortic root replacement at our hospital, with 13 being treated on an emergency basis. There were 189 men and 42 women, ranging in age from 14 to 69 years. The diameter of the aneurysm varied from 4.5 to 11 cm. Among this group, 145 had isolated aortic root aneurysms, 65 suffered from DeBakey type I aortic dissection, and the remaining 21 were diagnosed as having DeBakey type II aortic dissection. Aortic valve regurgitation occurred in all cases. Aortic root replacement was performed with composite valved graft in 229 patients, and in 2 patients the aortic valve was preserved. RESULTS: The hospital mortality rate was 3.03% (7 patients). Early complications included re-exploration for bleeding in 6 patients, pericardial effusion in 9, as well as cerebral infarction, pleural effusion, and pneumothorax in 2 patients each. One hundred and seventy-five patients (78.12%) were followed up, with a mean follow-up time of 15.7 +/- 13.1 months (range, 2 weeks to 65 months). One patient died from lower-limb embolism and renal dysfunction 3 months postoperatively. Three patients died from postoperative anticoagulation accidents. The preoperative and postoperative mean left ventricular end-diastolic diameters were significantly different (68.1 +/- 9.4 mm, range 54 to 112 mm; vs 54.8 +/- 8.2 mm, range 38 to 88 mm; P < 0.001). CONCLUSIONS: Once a diagnosis of acute aortic root dissecting aneurysm is made, the patient should undergo surgery as soon as possible if the general conditions permit. Aortic aneurysm without dissection or with chronic dissection should be operated if the diameter of the aneurysm is greater than 5 cm.