Analysis of aortic root surgery with composite mechanical aortic valve conduit and valve-sparing reconstruction

作者：Dias Ricardo Ribeiro^*; Vilca Mejia Omar Asdrubal; Fiorelli Alfredo Inacio; Alberto Pomerantzeff Pablo Maria; Dias Altamiro Ribeiro; Mady Charles; Groppo Stolf Noedir Antonio

来源：Brazilian Journal of Cardiovascular Surgery, 2010, 25(4): 491-499.

DOI：10.1590/S0102-76382010000400012

• Aorta
• Aortic aneurysm, thoracic
• Aortic valve insufficiency
• Aortic valve

Objective: Comparative analysis of early and late results of aortic root reconstruction with aortic valve sparing operations and the composite mechanical valve conduit replacement.
Methods: From November 2002 to September 2009, 164 consecutive patients with mean age 54 +/- 15 years, 115 male, underwent the aortic root reconstruction (125 mechanical valve conduit replacements and 39 valve sparing operations). Sixteen percent of patients had Marfan syndrome and 4.3% had bicuspid aortic valve. One hundred and forty-four patients (88%) were followed for a mean period of 41.1 +/- 20.8 months.
Results: The hospital mortality was 4.9%, 5.6% in operations with valved conduits and 2.6% in the valve sparing procedures (P <0.05). There was no difference neither in survival (95% Cl = 86% - 96%, P= 0.1) nor in reoperation-free survival (95% CI = 85% - 90%, P = 0.29). The survival free of complications such as bleeding, thromboembolism and endocarditis were favorable to the valve sparing operations, respectively (95% CI = 70% - 95%, P = 0.001), (95% Cl = 82% - 95% P= 0.03) and (95% CI = 81% - 95%, P = 0.03). Multivariate analysis showed that creatinine greater than 1.4 mg/dl, Cabrol operation and renal dialysis were predictors of mortality, respectively, with occurrence chance of 6(95% CI = 1.8 - 19.5, P = 0.003), 12(95% CI = 3 - 49.7, P = 0.0004) and 16 (95% CI = 3.6 - 71.3, P = 0.0002).
Conclusions: The aortic root reconstruction has a low early and late mortality, high survival free of complications and low need for reoperation. During the late follow-up, valve sparing aortic root reconstructions presented fewer incidences of bleeding, thromboembolic events and endocarditis.

• 出版日期2010-12