• Eur J Cardiothorac Surg · Oct 2014

    Comparative Study

    Aortic root replacement: comparison of clinical outcome between different surgical techniques.

    • Catalin Constantin Badiu, Marcus André Deutsch, Constantinos Sideris, Markus Krane, Ina Hettich, Bernhard Voss, Domenico Mazzitelli, and Rüdiger Lange.
    • Department of Cardiovascular Surgery, German Heart Centre Munich, Clinic at the Technical University Munich, Munich, Germany badiu@dhm.mhn.de.
    • Eur J Cardiothorac Surg. 2014 Oct 1;46(4):685-92; discussion 692.

    ObjectivesTo examine the influence of different surgical procedures on clinical outcome in patients undergoing aortic root replacement for ascending aorta aneurysm (AAA) with or without concomitant aortic valve regurgitation (AR).MethodsBetween 2000 and 2011, a total of 370 patients (mean age 52 ± 17 years) underwent aortic root replacement. Patients were retrospectively assigned to three groups according to the surgical procedures: valve-sparing root replacement (VSRR) (Group A; n = 178), Bentall procedure with a biological conduit (Group B; n = 91) and with a mechanical conduit (Group C; n = 101). All patients were studied with clinical assessment and echocardiography during a mean follow-up time of 4.3 years.ResultsEstimated 5-year survival probability rates for Groups A, B and C were 95.2 ± 1.8, 80.9 ± 4.4 and 79.3 ± 4.5%, respectively (P < 0.01; log-rank). Estimated 5-year survival probability rates for patients who had undergone elective operations for Groups A, B and C were 96.1 ± 1.8, 88.9 ± 4.4 and 82.3 ± 4.9%, respectively (P = 0.02; log-rank). Actuarial overall 5-year freedom from valve-related reoperations was 94.3 ± 1.9%, without being significantly different between groups (P = 0.13; log-rank). Estimated 5-year probability rates for freedom from major bleeding events for Groups A, B and C were 99.3 ± 0.7, 100 and 93.0 ± 3.4%, respectively (P = 0.03; log-rank). Actuarial overall 5-year freedom from thromboembolism and endocarditis were 93.6 ± 0.2% (P = 0.53; log-rank) and 96.1 ± 1.5% (P = 0.46; log-rank), respectively, without significant differences between groups.ConclusionsThe data from the present study support the VSRR strategy in patients undergoing aortic root replacement. Furthermore, if Bentall operation is unavoidable, biological valved conduit should be preferred in order to avoid late bleeding complications.© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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