Journal of cardiac surgery
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Until recently the surgical treatment of aneurysms of the aortic root in patients with the Marfan syndrome consisted of composite replacement of the aortic valve and ascending aorta. At the present, almost one-half of these patients can have reconstruction of the aortic root with preservation of the aortic valve. The mitral valve can also be frequently preserved. ⋯ Although the number of patients in each group is small and the follow-up relatively short, aortic valve-sparing operations have given gratifying results and may prove superior to valve replacement in patients with the Marfan syndrome.
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We currently routinely use profound hypothermic circulatory arrest (PHCA) with retrograde cerebral perfusion (RCP) during repair of proximal aortic dissection and aneurysms involving the transverse aortic arch. Experimental data regarding the efficacy of RCP are conflicting. We retrospectively reviewed our experience with proximal aortic surgery to compare the results of PHCA performed with and without RCP. ⋯ Patients who had RCP during PHCA had lower mortality and stroke rates than those who did not. Although the higher prevalence of cerebrovascular disease, diabetes, and dissection in the latter group may have contributed to these differences, the clinical results confirm the safety and potential benefits of RCP, further supporting its use during proximal aortic surgery requiring circulatory arrest.
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From October 1973 to December 1995, 251 patients (204 male, 47 female) aged from 10 to 75 years (mean: 46.6 +/- 15) underwent an ascending aortic replacement with a composite graft for: dystrophic aneurysm (AN), 168 cases (66.9%); chronic dissection (CD), 36 cases (14%); and type A acute dissection (AD), 48 cases (19.1%). Fifty-one patients (20.3%) suffered from Marfan's disease (25 AN, 17 AD, 9 CD). Thirty-seven patients (14.7%) had undergone a previous cardiac or aortic operation. The ascending aortic replacement was extended to the transverse arch in 31 patients (12.3%). A mechanical valve was used in 233 patients (92.8%). The classic "Bentall" technique was used in 87 patients (34.6%), the "button" technique in 121 patients (48.2%), the "Cabrol" technique in 26 patients (10.3%) and a "mixed" technique in 17 patients (6.2%). ⋯ Ascending aortic replacement with a composite graft is a safe procedure, especially when performed electively in patients with dystrophic aneurysm or Marfan's disease. The technique of coronary reimplantation has a significant influence of the long-term results, with the reimplantation of choice being the "button" technique. The "Cabrol" technique must be used when the "button" or the "Bentall" reimplantation is not feasible.