CARDIOVASCULAR SURGERY

Embolic and bleeding events after modified Bentall procedure in selected patients

N C Radu¹, E W M Kirsch¹, M-L Hillion¹, F Lagneau², L Drouet³, D Loisance¹

¹ Departments of Chirurgie Thoracique et Cardiovasculaire, Créteil, France
² Departments of Anesthésie et Réanimation Chirurgicale Hôpital Henri Mondor, Créteil, France
³ Department of Hematology, Hôpital Lariboisière, Paris, France

Correspondence to:
M E W M Kirsch
Department of Cardiothoracic Surgery, Hospital Henri Mondor, 51 Avenue Marechal de Lattre de Tassigny, 94000 Créteil Cedex, France;matthias.kirsch{at}hmn.aphp.fr

Aim: As valve-sparing procedures gain increasing popularity, the long-term results of the total aortic root replacement (TARR) were evaluated using mechanical valve grafts in selected patients.

Methods and results: From January 1993 to December 2003, 100 patients (87 men), aged >65 years (mean 51 (SD 10.4 years), presenting with isolated aortic root dilatation with or without aortic valve insufficiency, undergoing elective root replacement using a mechanical valve graft were reviewed. The aetiology of aortic root disease was degenerative in 69 patients and related to the bicuspid aortic valve in 31 patients. In 11 patients, concomitant coronary artery bypass graft was performed. Hospital mortality was 4%. Overall survival was 93.9% (2.4%), 89.1% (3.5%) and 83.2% (5.2%) at 1, 5 and 7 years, respectively. 14 patients experienced 45 embolic events (3.21 (2.64) events/patient; range: 1–10 events). Thus, the linearised rate of embolic events was 10.3 per 100 patient-years (95% confidence interval (CI) 7.29 to 13.31). The actuarial embolism-free survival was 96.6% (1.9%), 77.1% (6%) and 74.3% (6.4%) at 1, 5 and 7 years, respectively. The linearised rate of bleeding events was 2.2 per 100 patient-years (95% CI 0.87 to 3.71). Actuarial bleeding free survival was 95.6% (2.1%), 93.2% (2.6%) and 87.7% (5.8%) at 1, 5 and 7 years. respectively. None of the patients required reoperation and no cases of structural or non-structural valve dysfunction were observed.

Conclusions: TARR using mechanical valve grafts yields excellent survival results in selected patients. However, a high rate of minor thromboembolic events was recorded. Aspirin in combination with oral anticoagulants might be of potential interest in these patients.

Abbreviations: TARR, total aortic root replacement

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Khaladj, N., Ismail, I., Shrestha, M., Peterss, S., Pichlmaier, M., Kallenbach, K., Haverich, A., Hagl, C. (2009). Aortic root surgery in combination with hypothermic circulatory arrest: preserve or replace the aortic valve in the context of postoperative neurological outcome? A case match comparison. ICVTS 9: 246-250 [Abstract] [Full Text]  
• Zannis, K., Deux, J.-F., Tzvetkov, B., Nakashima, K., Loisance, D., Rahmouni, A., Kirsch, M. E.W. (2009). Composite Freestyle Stentless Xenograft With Dacron Graft Extension for Ascending Aortic Replacement.. Ann. Thorac. Surg. 87: 1789-1794 [Abstract] [Full Text]  
• Kirsch, M. E.W., Ooka, T., Zannis, K., Deux, J.-F., Loisance, D. Y. (2009). Bioprosthetic replacement of the ascending thoracic aorta: what are the options?. Eur. J. Cardiothorac. Surg. 35: 77-82 [Abstract] [Full Text]  
• Lansac, E., Di Centa, I., Raoux, F., Attar, N. A., Acar, C., Joudinaud, T., Raffoul, R. (2008). A lesional classification to standardize surgical management of aortic insufficiency towards valve repair. Eur. J. Cardiothorac. Surg. 33: 872-878 [Abstract] [Full Text]