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The Journal of Thoracic and Cardiovascular Surgery, Vol 91, 17-25, Copyright © 1986 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
C Cabrol, A Pavie, P Mesnildrey, I Gandjbakhch, L Laughlin, V Bors and T Corcos
From November, 1976, to June, 1983, 100 patients, 84 male and 16 female
patients ranging in age from 13 to 74 years, were operated on for aortic
insufficiency associated with an aneurysm of the ascending aorta. Twenty
patients were in New York Heart Association Class I, 22 in Class II, 51 in
Class III, and seven in Class IV. The surgical treatment in all cases
consisted of total replacement of the ascending aorta with a tube graft
containing a prosthetic aortic valve and reimplantation of the coronary
arteries by an intermediate tube graft according to the technique already
reported. In 68 patients an uncomplicated annulo-aortic ectasia existed,
and in 32, an aortic dissection; nine of the latter group were operated on
during the acute phase. The operative mortality for the entire group was 4%
(four deaths). One patient has been lost to follow-up during a period
ranging from 18 months to 8 years (average 54 months). The late mortality
has been 11/96. Among the 84 survivors, clinical improvement is readily
apparent (89% are in Class I or II). Twenty-five patients have been
restudied by angiography, which revealed a satisfactory coronary and aortic
appearance in all cases with neither stenosis nor aneurysm. The actuarial
survival rate is 75% at 8 years. In conclusion, the treatment of aortic
insufficiency associated with an aneurysm of the ascending aorta by
insertion of a composite graft and reimplantation of the coronary arteries
through an intermediate Dacron tube is a reliable method with low mortality
and excellent long-term results.
ARTICLES
Long-term results with total replacement of the ascending aorta and reimplantation of the coronary arteries
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