Korean J Thorac Cardiovasc Surg.  2013 Apr;46(2):104-110. 10.5090/kjtcs.2013.46.2.104.

Long Term Outcomes of Aortic Root Replacement: 18 Years' Experience

• Bang JH
• Im YM
• Kim JB
• Choo SJ
• Chung CH
• Lee JW
• Jung SH

• KMID: 1427803
• DOI: http://doi.org/10.5090/kjtcs.2013.46.2.104

Abstract

BACKGROUND
We reviewed the long-term outcomes of aortic root replacement at Asan Medical Center and investigated the predictors affecting mortality.
MATERIALS AND METHODS
A retrospective analysis was performed on 225 consecutive adult patients undergoing aortic root replacement with mechanical conduits (n=169), porcine aortic root prosthesis (n=23), or aortic homografts (n=33) from January 1992 to September 2009. The median follow-up duration was 6.1 years (range, 0 to 18.0 years).
RESULTS
The porcine root group was older than the other groups (freestyle 55.9+/-14.3 years vs. mechanical 46.3+/-14.6 years, homograft 48.1+/-14.7 years; p=0.02). The mechanical group had the highest incidence of the Marfan syndrome (mechanical 22%, freestyle 4%, homograft 3%; p=0.01). Surgery performed for infective endocarditis was more frequent in the homograft group (mechanical 10%, freestyle 10%, homograft 40%; p<0.001). The overall 30-day mortality was 5.3% (12/225). Actuarial survival rates in the mechanical, porcine root, and homograft groups were 79.4%, 81.5%, and 83.5% at 5 years and 67%, 61.9%, and 61.1% at 10 years, respectively (p=0.73). By multivariate analysis, preoperative diabetes mellitus, older age, and longer cardiopulmonary bypass time were independent predictors of mortality. Incidence of postoperative complications, including infective endocarditis and thromboembolism were comparable in all of the groups.
CONCLUSION
Aortic root replacement can be safely performed with different types of prostheses as the outcome was not affected by the choice of prosthesis. Further studies are required to assess the long-term durability of biological prostheses.

Keyword

Aorta, surgery; Heart valve prosthesis; Follow-up studies; Aortic valve, surgery

MeSH Terms

Adult
Cardiopulmonary Bypass
Diabetes Mellitus
Endocarditis
Follow-Up Studies
Heart Valve Prosthesis
Humans
Incidence
Marfan Syndrome
Multivariate Analysis
Postoperative Complications
Prostheses and Implants
Retrospective Studies
Survival Rate
Thromboembolism
Transplantation, Homologous