Original Research Articles
AORTA, Article in Press
Surgical Treatment of Annuloaortic Ectasia: Replace or Repair?
1 Section of Cardiac Surgery, Cardiac Thoracic and Vascular Department,
University Hospital, Pisa, Italy
2 Division of Cardiac Surgery, University of Verona, Verona, Italy
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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