BAGHIATALLAH UNIVERSITY OF MEDICAL SCIENCES TEHRAN, IRAN
Background: Aortic root reconstruction remains a challenging surgical procedure. Although several surgical approaches have been introduced, but their mortality and morbidity rate are still high. This study was carried out to evaluate the early and mid-term outcome of aortic root replacement in a referral center in Iran.
Methods: Between March 1993 and April 2003, 83 patients who underwent Bentall operation were studied. The mean age was 43.2±14 years, ranging from 10 to 78 years old. 78.3% of cases were male. Dyspnea and chest pain were the most common complaints. Aortic dissection (type A) was seen in 28% of cases and 24% had Marfan syndrome. Emergent operation was done, in 18.1%. The average cardiopulmonary bypass (CPB) time was 155.3±61 minutes and aortic cross clamp time was 106.8±35 minutes. Follow-up period ranged from 1 to 120 months with a mean of 29.6±28 months.
Results: The overall mortality rate was 15.7% (13 cases). Eleven deaths occurred in the hospital during the early postoperative days, and two deaths occurred within the follow-up period. Severe left ventricular failure, sepsis and bleeding were the most important causes of death. Two deaths occurred as a result of resistant tachyarrhythmia and acute MI. The mortality rate was significantly higher in those who presented with cardiogenic shock, had longer CPB and aortic cross clamping (AOX) time and finally in the cases with concomitant coronary artery bypass graft (CABG) surgery. Age, sex, underlying disease, pathology, ejection fraction, surgeon, emergent operation, Marfan syndrome, surgical techniques, amount of post- operative bleeding and the severity of aortic insufficiency did not affect mortality significantly. The neurological problems and postoperative mediastinal bleeding were the most common complications.
Conclusion: The early mortality rate in our series was relatively higher than the other studies; however, the mid-term survival in our series was excellent. The clear risk factors for early mortality in our investigation were CBP time>180 min, AOX>120 min, presentation with cardiogenic shock and concomitant CABG. Despite the previous reports, factors like emergent operation, age>65 and LVEF<40% were not predictors for higher mortality rates in our study. We hope to offer a better prognosis by improvement of operative technique, good myocardial and cerebral protection and reducing the CPB and AOX times.