Key result
Ascending aortic replacement yields ~16% higher long-term survival for dystrophic aneurysm versus acute dissection.
Why the study?
Factors influencing immediate and long-term results after ascending aortic replacement with composite grafts were not fully characterized across different coronary reimplantation techniques.
Does the technique of coronary reimplantation influence long-term survival in patients undergoing ascending aortic replacement with a composite graft?
Cohort (n=203)
Does the technique of coronary reimplantation influence long-term survival in patients undergoing ascending aortic replacement with a composite graft?
Absolute Event Rate: 77.8% vs 61.6%
p-value: p=<0.01
Ascending aortic replacement with a composite graft is a safe procedure, and the 'button' technique for coronary reimplantation yields superior long-term survival compared to other methods.
Observed survival advantage for dystrophic aneurysm over acute dissection after composite grafting; leaves open whether coronary reimplantation technique affects outcomes.
From April 73 to June 94, 203 patients (167 men, 36 women) aged from 10 to 74 years (mean: 44.8 +/- 15) underwent ascending aortic replacement with composite graft for: dystrophic aneurysm (AN) (130 cases, 64.5%), chronic dissection (CD) (35 cases, 17.2%), type A acute dissection (AD) (38 cases, 18.7%). Forty-six patients (22.6%) suffered from Marfan syndrome (24 AN, 13 AD, 9 CD). Thirty patients (14.7%) had undergone a previous cardiac or aortic operation. The ascending aortic replacement was extended to the transverse arch in 28 patients (13.7%). A mechanical valve was used in 193 cases (95%). Since 1986, the ascending aorta has been totally resected and a gelatin-or collagen-coated vascular prosthesis used. The technique of coronary reattachment has varied with time and according to the aortic lesions. The classic "Bentall" technique was used in 87 patients (43%), the "button" technique in 74 (36%), the "Cabrol" technique in 26 (13%) and a "mixed" technique in 16 cases (8%). The hospital mortality rate was 7.3% (15/203) (AN: 2.3%, CD: 11.4%, AD: 21%). The only predictors of hospital death were emergency AD (P < 0.03) and arch replacement (P < 0.02). Mean follow-up was 46 +/- 10 months (2-246). The overall long-term survival rate was (Kaplan Meier) 89 +/- 6% at 1 year, 77.9 +/- 9% at 5 years, 67.7 +/- 12% at 10 years and 61.3 +/- 15% at 12 years. The 10-year survival rate is significantly higher in patients with AN (77.8 +/- 11%) than in those with AD (61.6 +/- 17%) (log. rank: P < 0.01). The late survival rate is also significantly higher after the "button" or Bentall reimplantation than after the "Cabrol" or "mixed" methods (90 +/- 5% in the "button" group and 88.7 +/- 6%, 83.8 +/- 9% and 76.6 +/- 12% in the "Bentall" group vs 80 +/- 18%, 63 +/- 21% and 58 +/- 35% in the "Cabrol" group at 1, 5 and 8 years, respectively). In conclusion, ascending aortic replacement with a composite graft is a safe procedure especially when performed electively in patients with dystrophic aneurysm or Marfan syndrome. The technique of coronary reimplantation has a significant influence on the long-term results. The reimplantation of choice is the "button" technique, especially in the presence of a fragile aortic wall (AD). The "Cabrol" technique must be used when the "button" or the "Bentall" reimplantation is not feasible, for instance during redo procedures.
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Bachet et al. (1996) conducted a cohort in Aortic root disease (dystrophic aneurysm, chronic dissection, acute dissection) (n=203). Ascending aortic replacement with a composite graft was evaluated on 10-year survival rate (dystrophic aneurysm vs acute dissection) (p=<0.01). Ascending aortic replacement with a composite graft yielded a 10-year survival rate of 77.8% for dystrophic aneurysm versus 61.6% for acute dissection (P<0.01).
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