Shaheed Rajaie Cardiovascular Medical Center, Tehran
Background- Composite aortic root replacement is the accepted treatment for acute dissections of the ascending aorta involving the root with aortic valve regurgitation, but controversy continues over the best technique of operation.
Methods- We reviewed all cases who underwent emergency operations in an over two-year period in our center for acute dissections of the ascending aorta in order to determine the surgeon’s preference concerning the technique of the operation and the outcome of the patients. Twenty-five patients underwent emergency surgery for acute ascending aortic dissections from Jan. 1998 to Jan. 2000. There were 21 male (84%) and 4 female patients (16%), and the average age was 48 years (range 25 to 68 years).
Results- Hospital death occurred in 5 (20%) patients. Return to the operating room for bleeding was required in 9 patients, and hospital mortality due to bleeding was 3 patients. Neurological deficits developed in 3 patients in the immediate postoperative period, two of whom recovered completely. The third patient also had renal and multiple organ failure and died. One patient required tracheostomy and ventilatory support for 3 weeks. This patient finally died because of sternal infection and sepsis.
Echocardiogram was done on follow-up for all patients, and showed no evidence of coronary or other anastomotic disruption. No reoperations were needed for anastomotic aneurysms at any site.
Conclusion- Higher bleeding and mortality rates in our series compared to those reported in the literature can be reduced with the newly introduced gelatin-coated graft material. Our technique includes excision of the dissected aortic wall, implantation of a composite valve-graft conduit, direct coronary implantation to the graft and distal anastomosis to the divided aorta