Objectives: The proper treatment of aneurysms of the ascending aorta is still under debate. Here, we describe the early and late outcomes after composite replacement (CR), supracommissural aortic replacement (SCR) and aortic valve-sparing (AVS) operations.
Methods: Five hundred and fourty-eight patients were operated on for ascending aortic aneurysm from 1994 until 2011. Two hundred and ninety-eight (54%) patients had CR, 154 (28%) underwent SCR, 96 (18%) received AVS using David's technique [83 (15%); after October 2006] and 13 (3%) using Yacoub's technique. The average size of the aneurysms was 5.8 ± 1.3 cm and differed between groups (P < 0.001). Patients in the SCR group were older (P < 0.001), and male gender was less frequent in the Yacoub group (P = 0.004). Marfan's syndrome was present more often in the AVS group (P < 0.001).
Results: Times for operation, extracorporeal circulation and aortic cross-clamping differed significantly (P < 0.001). In the SCR group, 40% of patients additionally underwent aortic valve replacement. Rethoracotomy for bleeding was required in 33 patients. Overall, 30-day mortality was 4.8% and did not differ between groups (SCR = 7.2%, CR = 4.8%, David's technique = 0% and Yacoub's technique = 8.3%; P = 0.12). Six patients experienced cerebral accidents. The follow-up was complete for 93%, and mean follow-up time was 3.9 ± 3.9 (0-17.8) years. Kaplan-Meier analysis revealed a significantly reduced long-term survival for women (log-rank P = 0.0052). Reoperation on the aortic root was necessary in only 6 patients from the Yacoub and SCR groups. No aortic dissection occurred. By uni- or multivariate regression analysis, age and preoperative creatinine were risk factors for 30-day mortality, and age, gender, creatinine, New York Heart Association class and chronic obstructive pulmonary disease, for long-term survival.
Conclusions: All four applied techniques result in low mortality and low reoperation rate and prevent aortic dissection. The David procedure yields excellent mid-term results.
Keywords: Aneurysms; Aorta; Cardiovascular diseases; Surgery; Valves.