Original Research Articles

AORTA, Article in Press
DOI: 10.12945/j.aorta.2017.17.044

Surgical Treatment of Annuloaortic Ectasia: Replace or Repair?

Andrea De Martino, MD1, Federico Del Re, MD1, Stefania Blasi, MD1,
Michele Celiento, MD1, Giacomo Ravenni, MD1, Stefano Pratali, MD1,
Aldo D. Milano, MD, PhD2, Uberto Bortolotti, MD1

1 Section of Cardiac Surgery, Cardiac Thoracic and Vascular Department,
University Hospital, Pisa, Italy
2 Division of Cardiac Surgery, University of Verona, Verona, Italy

Abstract

Background: Patients with annuloaortic ectasia may be treated with a modified Bentall or the David I valve sparing procedure. We have compared the long-term results of such operations.

Methods: 181 patients with annuloaortic ectasia had a modified Bentall (102 patients) (Group 1) or a David I (79 patients ) (Group 2) procedure from 1994 to 2015. Mean age was 62±11 years in Group 1 and 64±16 in Group 2. Group 1 patients were sicker with lower ejection fraction and higher functional class.

Results: Early mortality was 3% in Group 1 and 2.5% in Group 2. Patients with a modified Bentall had higher incidence of thromboembolism and hemorrages while those with a David I procedure had a higher incidence of endocarditis. Actuarial survival is 70±6% at 15 years in Group1 and 84±7% at 10 years in Group 2. Actuarial freedom from reoperation is 97±2% at 15 years in Group 1 and 84±7% at 10 years in Group 2. In Group 2 freedom from procedure-related reoperations at 10 years is 98±2%. At last follow-up no cases of moderate or severe aortic regurgitation were observed.

Conclusions: The modified Bentall and the David I procedures provided overall excellent early and late results. The modified Bentall using a mechanical conduit was associated with expected thromboembolic and hemorrhagic complications while the David I showed an unexplained rate of endocarditis. The David I procedure appears safe, reproducible and provides stable aortic valve repair thus representing currently our preferred solution for patients with annuoloaortic ectasia. However, the much shorter follow-up in Group 2 limits the strength of the comparison between the 2 techniques.

Cite this article as: De Martino A, Del Re F, Blasi S, Celiento M, Ravenni G, Pratali S, Milano AD, Bortolotti U. Surgical Treatment of Annuloaortic Ectasia: Replace or Repair?. Aorta (Stamford). DOI: 10.12945/j.aorta.2017.17.044 [In Press]

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