Composite valve graft replacement of the ascending aorta and the aortic valve by a modified button technique: the influence of aortic pathology on early mortality and late survival
The risk factors for in-hospital mortality and mid-term survival inpatients undergoing composite graft replacement of the aortic root withreimplant or coronary arteries by a modified button technique wereevaluated with special emphasis on the underlying aortic pathology. Between1985 and 1993 74 patients underwent replacement of the ascending aorta andthe aortic valve following a modified button technique. The patients weredivided into three groups according to aortic pathology: annuloaorticectasia (43.58%), type A dissection (18.24%), and miscellaneous (13.18%).In-hospital mortality rates were 4.7%, 33.3% and 23.1%, respectively (P =0.011). Univariate analysis showed that aortic pathology, NYHA class,emergency operation, redo operation, acute aortic dissection, preoperativecardiogenic shock, preoperative cardiac tamponade, longer cardiopulmonarybypass (CPB) and aortic cross-clamp times, and the need of femoral vein orfemoral artery cannulation at intervention had univariate influence on in-hospital mortality. Multivariable stepwise logistic regression analysisidentified CPB time odds ratio (OR) = 1.021/min, P = 0.007), the need offemoral vein cannulation at intervention (OR= 4.85, P = 0.008) andpreoperative cardiac tamponade (OR = 3.11, P = 0.07) as independentpredictors of in-hospital death. Follow-up ranged from 1 to 98 months (mean39 +/- 30 months) with an actuarial survival rate of 75 +/- 9%, 52 +/- 13%and 67 +/- 14% at 5 years in annuloaortic ectasia, type A dissection, andmiscellaneous patients, respectively (P = 0.18); when survival wasevaluated in hospital survivors only, Kaplan-Meier survival rates were 77+/- 9%, 79 +/- 14% and 89 +/- 10% at 5 years (P = 0.87). Comparing survivalof annuloaortic ectasia patients (5-year survival 75 +/- 9%) versussurvival of all other patients pooled together (5-year survival 55 +/-11%), there was a statistically significant difference (P < 0.05); sucha difference was no longer significant when comparing hospital survivorsalone (5-year survival rate 77 +/- 9% annuloaortic ectasia patients vs 79+/- 12% all other patients P = 0.61). Although aortic root replacementcarries higher in- hospital mortality in some high-risk subgroups ofpatients, mid-term survival seems to be less affected by aortic pathology;high-risk patients are expected to have an out-hospital outcome comparableto the low-risk ones.