Early and long-term outcome in patients undergoing aortic root replacement with composite graft according to the Bentall's technique

Abstract OBJECTIVES The goal of this study was to report the long-term outcomes of patients with Marfan syndrome who had aortic surgery on any aortic segment except for the replacement of the aortic root itself. METHODS An observational retrospective single-centre study was conducted with 115 Marfan syndrome patients who underwent 189 major aortic interventions from 1995 until 2018. Patients without aortic root replacement were identified and aortic root growth was analysed over time. RESULTS Eleven of 115 patients (9.5%) did not have aortic root replacement during a follow-up of 10.5 [standard deviation (SD) 5.7] years and a mean age at last follow-up of 53.9 (SD 13.4) years. Patients without root replacement did not suffer less frequently from any type of acute aortic dissection (type A 27% vs 25%, P = 0.999; type B 36% vs 25%, P = 0.474). Patients with native aortic roots did not undergo fewer aortic interventions than those with aortic root replacement [12/11, mean 1.09 (SD 0.54) operations/patient vs 177/104, mean 1.7 (SD 1.3); P = 0.128]. Progression of the aortic root dimension was 0.5 (SD 0.3) mm/year in the group of patients with native aortic roots. CONCLUSIONS Current data suggest that 10% of patients with Marfan syndrome with previous aortic surgery will be free from aortic root replacement until the sixth decade of life.

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Long-Term Outcome of Aortic Root Remodeling for Patients With and Without Acute Aortic Dissection

Circulation Journal ◽

10.1253/circj.cj-17-0182 ◽

2017 ◽

Vol 81 (12) ◽

pp. 1824-1831 ◽

Cited By ~ 5

Author(s):

Takashi Kunihara ◽

Niklas Neumann ◽

Steffen Daniel Kriechbaum ◽

Ryota Nomura ◽

Hans-Joachim Schäfers

Keyword(s):

Aortic Dissection ◽

Aortic Root ◽

Acute Aortic Dissection ◽

Term Outcome ◽

Long Term Outcome ◽

Aortic Root Remodeling

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Preoperative aortic root geometry and postoperative cusp configuration primarily determine long-term outcome after valve-preserving aortic root repair

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2011.07.036 ◽

2012 ◽

Vol 143 (6) ◽

pp. 1389-1395.e1 ◽

Cited By ~ 97

Author(s):

Takashi Kunihara ◽

Diana Aicher ◽

Svetlana Rodionycheva ◽

Heinrich-Volker Groesdonk ◽

Frank Langer ◽

...

Keyword(s):

Aortic Root ◽

Term Outcome ◽

Long Term Outcome ◽

Root Repair ◽

Aortic Root Repair

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Outcomes of Patients after Implantation of the Pericardial All-Biological Valve No-React Aortic Conduit (BioIntegral) for Root Replacement in Complex Surgical Procedures

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0039-1683425 ◽

2019 ◽

Vol 68 (04) ◽

pp. 301-308

Author(s):

Thomas Puehler ◽

Sandra Freitag-Wolf ◽

Christine Friedrich ◽

Mohamed Salem ◽

Jochen Renner ◽

...

Keyword(s):

Functional Status ◽

Survival Time ◽

Aortic Root ◽

Cox Regression ◽

Multiorgan Failure ◽

Aortic Root Replacement ◽

Long Term Outcome ◽

Cox Regression Analysis

Objective Therapy of complex aortic root pathologies remains a great surgical challenge. Though different graft materials are available to replace the often-destroyed aortic root, long durability and freedom from reoperation of the latter are still under debate. The aim of our study was to investigate patients' postoperative outcome after implantation of the BioIntegral conduit in complex aortic root pathologies. Methods From February 2014 to May 2017, 33 consecutive patients (69.7% male) with a median age of 73 (57.5; 76.2) years underwent aortic root replacement with the BioIntegral conduit at our institution. Severe aortic valve endocarditis (78.8%) was the predominant indication for surgery. In 28 patients (84.9%), implantation was performed as redo or in 87.8% as urgent and emergent surgery. Primary end-point was the 30-day survival time, evaluated by Cox regression analysis. Secondary midterm outcome and graft-related reoperation were analyzed. Results Median follow-up for all patients was 178 (8; 659) days. Median EuroScore II was 19.9% (13.4; 29.9). Freedom from reoperation was 97%. The overall 30-day mortality rate was 33% mainly caused by multiorgan failure in six (18.2%) patients and cardiac failure in five (15.1%) patients. One further death occurred during follow-up at day 156. None was directly conduit-related. Graft reinfection after the 4th surgery with basal abscess formation occurred in only one patient (3%). Early echocardiographic assessment of the valve revealed good functional results. A higher EuroScore II was significantly associated with a poorer 30-day survival time (hazard ratio, 1.039; 95% confidence interval, 1.015–1.063, p = 0.001). Conclusion Aortic root replacement for complex pathologies is associated with substantial 30-day mortality, but survival of patients after discharge from hospital was stable. Early functional status of the BioIntegral valve was good. Though freedom from re-operation was low, long-term outcome and long-term functional status have to be further evaluated.

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