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

P. Biglioli, A. Sala, R. Spirito, A. Parolari, M. Agrifoglio, F. Alamanni, F. Huang, P. Gerometta, V. Arena

Research output: Contribution to journalArticle

Abstract

The risk factors for in-hospital mortality and mid-term survival in patients undergoing composite graft replacement of the aortic root with reimplant of coronary arteries by a modified button technique were evaluated with special emphasis on the underlying aortic pathology. Between 1985 and 1993 74 patients underwent replacement of the ascending aorta and the aortic valve following a modified button technique. The patients were divided into three groups according to aortic pathology: annuloaortic ectasia (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, preoperative cardiogenic shock, preoperative cardiac tamponade, longer cardiopulmonary bypass (CPB) and aortic cross-clamp times, and the need of femoral vein or femoral artery cannulation at intervention had univariate influence on in-hospital mortality. Multivariable stepwise logistic regression analysis identified CPB time odds ratio (OR)=1.021/min, P=0.007), the need of femoral vein cannulation at intervention (OR=4.85, P=0.008) and preoperative cardiac tamponade (OR=3.11, P=0.07) as independent predictors of in-hospital death. Follow-up ranged from 1 to 98 months (mean 39±30 months), with an actuarial survival rate of 75±9%, 52±13% and 67±14% at 5 years in annuloaortic ectasia, type A dissection, and miscellaneous patients, respectively (P=0.18); when survival was evaluated in hospital survivors only, Kaplan-Meier survival rates were 77±9%, 79±14% and 89±10% at 5 years (P=0.87). Comparing survival of annuloaortic ectasia patients (5-year survival 75±9%) versus survival of all other patients pooled together (5-year survival 55±11%), there was a statistically significant difference (P

Original languageEnglish
Pages (from-to)483-490
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Volume9
Issue number9
Publication statusPublished - 1995

Keywords

  • Ascending aorta
  • Composite graft valve replacement
  • Risk factors survival
  • Statistical analysis

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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