Composite valve graft implantation for the treatment of aortic valve and root disease: Results in 1045 patients.

Objectives: Aortic root replacement using a composite graft is the treatment of choice for a large variety of aortic root conditions with a diseased aortic valve. The objective of the current study was to evaluate the long-term results of this procedure. Methods: Between 1978 and 2010, 1045 patients aged 58.7 +/- 13.6 years underwent aortic root composite graft replacement using the following techniques: 95 Bentall operation; 926 the "button technique;" 24 the Cabrol technique. A mechanical composite valve graft was implanted in 69.6% of the patients. Sixhundred and thirty-five patients ( 62.3%) had annuloaortic ectasia and 162 ( 15.5%) had aortic dissection. Results: Early mortality was 5.3% ( 55/1045). Independent risk factors for early mortality at logistic regression analysis were age >= 70 years ( P =.051; odds ratio [ OR], 2.97), New York Heart Association III-IV ( P =.052; OR, 1.88), reoperation ( P =.021; OR, 2.36), urgency/emergency ( P =.003; OR, 3.09), mitral valve replacement ( P =.001; OR, 6.01), or coronary artery bypass grafting ( CABG) ( P<. 001; OR, 4.39); while bicuspid aortic valve ( BAV) ( P =.013; OR, 0.21), and time of operation 2001-2011 ( P =.025; OR, 0.60) were protective predictors for early mortality. Overall survival at 5, 10, and 20 years was 84.1% +/- 1.3%, 65.5% +/- 2.6%, and 40.7% +/- 4.6%, respectively. Multivariate analysis revealed chronic renal insufficiency ( P =.001; hazard ratio [ HR], 3.48), chronic obstructive pulmonary disease ( P =.027; HR, 1.94), aortic dissection ( P =.001; HR, 2.63), Cabrol technique ( P =.009; HR, 15.34), and CABG ( P =.016; HR, 2.02) to be significant predictors of late death, and BAV ( P =.010; HR, 0.43) to be a significant protective predictor. Freedom from thromboembolism, bleeding complications, and endocarditiswas 93.7% +/- 2.6%, 90.3% +/- 3.1%, and 98.4% +/- 1% at 20 years, respectively. Freedom from aortic reoperation was 91.8% +/- 2.1% at 20 years and was significantly lower in patients with aortic dissection. Conclusions: Within the limitations of this retrospective study, we can conclude that aortic root replacement for aortic root aneurysms can be performed with low morbidity and mortality and with satisfactory long-term results. Few late serious complications were related to the need for long-term anticoagulation or a prosthetic valve. Reoperation on the proximal or in the distal aorta was most commonly performed in patients with aortic dissection.