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ULTIMO FASCICOLOTHE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2001 Agosto;42(4):509-16

VASCULAR SECTION 

 ORIGINAL ARTICLES

Valve-preserving surgery of the proximal aorta

Schäfers H. J.

From the Depart­ment of Tho­racic and Car­di­o­vas­cular Sur­gery, Uni­ver­sity Hos­pi­tals, Hom­burg/­Saar, Germany

Back­ground. Sur­gical treat­ment of prox­imal ­aortic dis­ease cur­rently ­offers a ­variety of sur­gical ­options. Tra­di­tion­ally, replace­ment of the prox­imal ­aorta has ­been per­formed ­with a com­posite ­graft in ­most ­cases; supra­com­mis­sural ­aortic replace­ment was the ­only alter­na­tive if pres­er­va­tion of the ­native ­aortic ­valve was ­attempted. ­Valve-pre­serving ­root oper­a­tions cur­rently ­allow us to ­avoid the dis­ad­van­tages of pros­thetic ­heart ­valves and com­pletely elim­i­nate ­aortic ­root ­pathology.
­Methods. ­Between 10/95 and 5/99, 219 ­patients ­were ­treated for prox­imal ­aortic dis­ease. The diag­noses ­included degen­er­a­tive dis­ease (n=158), ­acute dis­sec­tion (n=48), and ­chronic dis­sec­tion (n=13). Com­posite replace­ment of ­valve and ­root (n=99) was ­used ­only in ­patients ­with sig­nif­i­cant degen­er­a­tion or sten­osis of the ­aortic ­valve. For ­near-­normal ­root dimen­sions supra­com­mis­sural ­aortic replace­ment (n=44) was ­chosen. ­Root remod­eling (n=60) and reim­plan­ta­tion of the ­valve ­within a vas­cular ­graft (n=16) ­were per­formed for ­aortic ­valve regur­gi­ta­tion and ­root dil­a­ta­tion.
­Results. ­Overall hos­pital mor­tality was 5.7%; in elec­tive oper­a­tions, mor­tality was expect­edly ­lower com­pared to emer­gency inter­ven­tions (2.4% vs 16.3%; p<0.05). Hos­pital mor­tality for ­valve pre­serving pro­ce­dures was sim­ilar (elec­tive pro­ce­dures 1.9%, emer­gency oper­a­tions 9.5%). Two-­year ­freedom ­from ­aortic regur­gi­ta­tion ­grade II or ­higher was 89% for remod­eling and 92% for reim­plan­ta­tion. ­Freedom ­from reop­er­a­tion for sec­on­dary and ­increasing regur­gi­ta­tion at two ­years was 96% for remod­eling and 100% ­after reim­plan­ta­tion.
Con­clu­sions. ­Using cur­rent tech­niques of ­valve pre­serving sur­gery, com­bined dis­ease of ­the aortic ­valve, ­root, and ­extended seg­ments of the ­aorta can be cor­rected ­without the dis­ad­van­tages of pros­thetic ­heart ­valves in the ­majority of ­patients. Fur­ther expe­ri­ence ­will ­define the rel­a­tive ­role of the dif­ferent oper­a­tive mo-d­ifi­ca­tions.

lingua: Inglese


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