Replacement of the ascending aorta and aortic valve with a composite graft: operative and long-term results.

The purpose of this study is to analyze our treatment experience on patients with ascending aortic aneurysms, with aortic regurgitation. From January 1974 to December 1995, 49 patients underwent replacement of the aortic valve and ascending aorta with a composite graft, in which primary operation cases were 44 and reoperation ones were 5. The Bentall technique was used in 20 patients, the button technique in 11, the interposition graft technique in 11, and a combination of the interposition graft and button technique in 7. All but one reoperation cases underwent the interposition graft technique. Hospital mortality was 30% for the Bentall technique, and 9.1% for the button technique and 9.1% for the interposition graft technique; there was no hospital mortality in the combination of the interposition graft and button technique. Hospital mortality of interposition graft technique in primary operation cases was 9.1%, and that in reoperation cases was 0%. Hospital mortality in patients underwent from 1974 to 1985 was 30.8%, 27.8% from 1986 to 1991, and 0% from 1992 to 1995. Five late deaths occurred in the Bentall group (35.7%) and one late death in the button technique (9.1%). Not late deaths in the other groups have occurred. In summary, operative mortality in Bentall technique group was higher than that of the other groups. Operative results were improved by the change of operative methods. The interposition graft technique is preferable for patients undergoing reoperation or when tension on the ostial anastomoses may occur. The button technique is best for patients with aortic dissection or inflammation involving the coronary ostia.

[Single-stage correction of coarctation of the aorta with aortic regurgitation].

A successful single-stage correction of coarctation of the aorta with aortic regurgitation is reported. A 39-year-old man was referred for angina, ankle swelling, and numbness of lower extremities. Aortogram revealed severe aortic regurgitation and coarctation of the aorta with 2.8 mm minimum diameter. Aortic valve replacement was performed under separate perfusion of upper and lower body, after which the coarctectomy and graft interposition were done under the left heart bypass. The patient was discharged in good condition with minor medication of digitalis and anticoagulant agents. As far as the case is concerned, the left heart bypass during graft interposition has possible risk of cardiac arrest and usual cardiopulmonary bypass is hazardous when complicated by severe coarctation of the aorta. Surgical procedure and assist methods used in this case were quite useful for coarctation of the aorta with aortic regurgitation.

Thoracic aortic operations in patients aged 70 years or older.

Thirty-one patients over the age of 70 years (group A) and 72 patients less than 69 years (group B) underwent a variety of thoracic aortic surgical procedures. Early and long-term results and cerebral function were compared between the two groups. Preoperative and postoperative cerebral function was evaluated using mini mental state-Himeji and Wechsler adult intelligence scale tests. The operative mortality of groups A and B was 12.9% and 11.1%, respectively (not significant). There were no significant differences in postoperative complications between the two groups. The late mortality rates of groups A and B were 11.1% and 9.3%, respectively (not significant). There were no significant differences between the two groups in the mini mental state-Himeji test, digit symbol, vocabulary, and total Wechsler adult intelligence scale scores before and after operation. We conclude that thoracic aortic surgical procedures in patients over 70 years of age can be performed with acceptable mortality and morbidity risks. Most patients showed symptomatic improvement.