Long-term Results Of Concomitant Freestyle Aortic Root Replacementand Reconstruction Of The Ascending Aorta
John R. Doty, Rafe C. Connors, William T. Caine, Jean H. Flores, Bruce B. Reid.
Intermountain Medical Center, Murray, UT, USA.
Concomitant ascending aortic aneurysm and aortic valve disease is common in bicuspid aortic valve or in older patients with degenerative valve disease and hypertension. Bioprosthetic aortic root replacement can be combined with a traditional ascending graft for concomitant aortic root and ascending aorta reconstruction for simultaneous treatment of all existing pathology.
One hundred consecutive patients underwent elective concomitant aortic root replacement with a Medtronic FreestyleŠ bioprosthesis and ascending aorta reconstruction with a prosthetic graft during a 17-year period. Indications for root replacement were dilation of all three aortic sinuses, small aortic root, or failed prior root replacement. Patients were followed with scheduled clinic evaluation and transthoracic echocardiography.
There was one operative mortality and one permanent neurologic complication. Mean length of follow-up was 5.2 years (range 1 week to 14.9 years). There was no valve-related mortality or death attributable to aortic disease. Freedom from thromboembolism, endocarditis, and reoperation for valvular disease was 97%, 98%, and 93%, respectively. At last follow-up, 6 patients required reintervention; 2 for endocarditis, 3 for structural valve dysfunction and 1 for pseudoaneurysm. Four patients underwent successful transcatheter valve replacement and two patients required redo mechanical valve replacement. Echocardiography was performed at a mean of 4 years (range 1 week to 14 years). Mean and peak gradients were 5 mmHg (range 2 to 14) and 9 mmHg (range 2 to 30), respectively. One patient developed valve thrombosis which was successfully treated with anticoagulation. No patient developed permanent valve-related impairment or additional aortic pathology.
Concomitant Freestyle aortic root replacement and ascending aortic reconstruction is a safe and effective approach that eliminates both valvular and aortic pathology, and may subsequently reduce the incidence of reoperation for either disease. We recommend prompt intervention for such patients when appropriate criteria are met for either valvular or aortic indications.
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