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Thorac Cardiovasc Surg 1979; 27(1): 24-30
DOI: 10.1055/s-0028-1096214
Copyright © 1979 by Georg Thieme Verlag

Surgical Treatment of Aneurysms of the Ascending Aorta: Early Experience with the Sinus-shaped Composite Dacron Graft

V. O. Björk, L. Bergdahl, A. Henze
  • Thoracic Surgical Clinic, Karolinska Sjukhuset, Stockholm, Sweden
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Publikationsdatum:
10. Dezember 2008 (online)

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Summary

This paper reviews the early and late results of 36 operations for aneurysms of the ascending aorta. Cystic medial necrosis was the predominant cause of aneurysm formation (56 %), followed by arteriosclerosis (25 %), previous aortotomy (11 %) and syphilitic aortitis (8 %). Dissection was encountered in 42 %. The ascending aorta was replaced by a tubular Dacron graft in 26 patients, whereas 10 underwent aneurysmorrhaphy. Additional procedures were aortic valve replacement (27), resuspension of the aortic commissures (4) and coronary ostial implantation into sinus-shaped composite Dacron graft (4).

Hospital mortality (0–18 days) was 8/36 patients (22 %), but higher with cystic medial necrosis (30 %), dissection (33 %), duration of ECC > 180 minutes (38 %), graft replacement (44 %), emergency operation (45 %) and heart volume > 900 ml/m2 BSA (50 %). Late mortality (average 3 years) was 29 %, but higher with cystic medial necrosis (33 %), following aortic valve replacement (36 %) and during anticoagulation (47 %). Late cumulative survival (average 3 years) was 47 % for the entire series, but only 33 % in the presence of cystic medial necrosis.

The poor overall prognosis for patients with cystic medial degeneration was closely related to a high incidence of fatal anastomotic complications and late deaths from cerebral haemorrhage during anticoagulation. Radical exclusion of the diseased aortic wall and omission of long-term anticoagulation are therefore desirable in order to lower the mortality rate. Surgery concerns the aneurysm per se, the aortic incompetence and the coronary ostia. The sinus-shaped composite graft with a Björk-Shiley prosthesis at its base appears to be a promising device for such a procedure, which should be performed electively, following early diagnosis in order to prevent dissection and emergeny operations.

Key-Words:

Aortic aneurysm, ascending - Surgical treatment - Aortic valve replacement - Aortic aneurysmorrhaphy