Surgery for aneurysms of the aortic root: A 30-year experience

Kenton J. Zehr, Thomas A. Orszulak, Charles J. Mullany, Alireza Matloobi, Richard C. Daly, Joseph A. Dearani, Thoralf M. Sundt, Francisco J. Puga, Gordon K. Danielson, Hartzell V Schaff

Research output: Contribution to journalArticle

149 Citations (Scopus)

Abstract

Background-This study evaluated long-term results of aortic root replacement and valve-preserving aortic root reconstruction for patients with aneurysms involving the aortic root. Methods and Results-Two-hundred three patients aged 53±16 years (mean±SD; 153 male, 50 female) underwent elective or urgent aortic root surgery from 1971 to 2000 for an aortic root aneurysm: 149 patients underwent a composite valve conduit reconstruction, and 54 patients underwent valve-preserving aortic root reconstruction. Fifty patients had Marfan syndrome. In-hospital and 30-day mortality was 4.0% (8/203) overall: for a composite valve conduit procedure, the corresponding value was 4.0% (6/149) and for valve-preserving procedure, 3.7% (2/54) (P=NS). Morbidity included 3 strokes (1%), 10 perioperative myocardial infarctions (5%), and 8 reoperations for bleeding (4%). Actuarial survival at 5, 10, 15, and 20 years was 93% (95% confidence interval [CI] = 88% to 97%), 79% (95% CI = 71% to 87%), 67% (95% CI = 57% to 79%), and 52% (95% CI = 36% to 69%), respectively. Freedom from reoperation was 72% (95% CI = 54% to 86%) at 20 years. Complications with anticoagulation occurred in 29 patients; with valve thrombosis, in 2; and with hemorrhage, in 27 (4 life threatening and 23 minor). Freedom from thromboembolism was 91% (95% CI = 77% to 98%) at 20 years. Freedom from endocarditis was 99% (95% CI = 92% to 100%) at 20 years. Multivariate analysis revealed preoperative mitral valve regurgitation (+3 to 4) and older age to be significant predictors of late death (P≤0.005), and Marfan syndrome, initial valve-preserving aortic root reconstruction, and need for a concomitant procedure at initial operation to be significant predictors of the need for reoperation (P-≤0.01). Conclusions-Aortic root replacement for aortic root aneurysms can be done with low morbidity and mortality. Composite valve conduit reconstruction resulted in a durable result. There were few serious complications related to the need for long-term anticoagulation or a prosthetic valve. Reoperation was most commonly required because of failure of the aortic valve when a valve-preserving aortic root reconstruction was performed or for other cardiac or aortic disease elsewhere.

Original languageEnglish (US)
Pages (from-to)1364-1371
Number of pages8
JournalCirculation
Volume110
Issue number11
DOIs
StatePublished - Sep 14 2004

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Aortic Aneurysm
Aortic Valve
Confidence Intervals
Reoperation
Marfan Syndrome
Hemorrhage
Morbidity
Aortic Diseases
Mortality
Thromboembolism
Mitral Valve Insufficiency
Endocarditis
Heart Diseases
Thrombosis
Multivariate Analysis
Stroke
Myocardial Infarction
Survival

Keywords

  • Aneurysm
  • Aorta
  • Surgery

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Zehr, K. J., Orszulak, T. A., Mullany, C. J., Matloobi, A., Daly, R. C., Dearani, J. A., ... Schaff, H. V. (2004). Surgery for aneurysms of the aortic root: A 30-year experience. Circulation, 110(11), 1364-1371. https://doi.org/10.1161/01.CIR.0000141593.05085.87

Surgery for aneurysms of the aortic root : A 30-year experience. / Zehr, Kenton J.; Orszulak, Thomas A.; Mullany, Charles J.; Matloobi, Alireza; Daly, Richard C.; Dearani, Joseph A.; Sundt, Thoralf M.; Puga, Francisco J.; Danielson, Gordon K.; Schaff, Hartzell V.

In: Circulation, Vol. 110, No. 11, 14.09.2004, p. 1364-1371.

Research output: Contribution to journalArticle

Zehr, KJ, Orszulak, TA, Mullany, CJ, Matloobi, A, Daly, RC, Dearani, JA, Sundt, TM, Puga, FJ, Danielson, GK & Schaff, HV 2004, 'Surgery for aneurysms of the aortic root: A 30-year experience', Circulation, vol. 110, no. 11, pp. 1364-1371. https://doi.org/10.1161/01.CIR.0000141593.05085.87
Zehr KJ, Orszulak TA, Mullany CJ, Matloobi A, Daly RC, Dearani JA et al. Surgery for aneurysms of the aortic root: A 30-year experience. Circulation. 2004 Sep 14;110(11):1364-1371. https://doi.org/10.1161/01.CIR.0000141593.05085.87
Zehr, Kenton J. ; Orszulak, Thomas A. ; Mullany, Charles J. ; Matloobi, Alireza ; Daly, Richard C. ; Dearani, Joseph A. ; Sundt, Thoralf M. ; Puga, Francisco J. ; Danielson, Gordon K. ; Schaff, Hartzell V. / Surgery for aneurysms of the aortic root : A 30-year experience. In: Circulation. 2004 ; Vol. 110, No. 11. pp. 1364-1371.
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abstract = "Background-This study evaluated long-term results of aortic root replacement and valve-preserving aortic root reconstruction for patients with aneurysms involving the aortic root. Methods and Results-Two-hundred three patients aged 53±16 years (mean±SD; 153 male, 50 female) underwent elective or urgent aortic root surgery from 1971 to 2000 for an aortic root aneurysm: 149 patients underwent a composite valve conduit reconstruction, and 54 patients underwent valve-preserving aortic root reconstruction. Fifty patients had Marfan syndrome. In-hospital and 30-day mortality was 4.0{\%} (8/203) overall: for a composite valve conduit procedure, the corresponding value was 4.0{\%} (6/149) and for valve-preserving procedure, 3.7{\%} (2/54) (P=NS). Morbidity included 3 strokes (1{\%}), 10 perioperative myocardial infarctions (5{\%}), and 8 reoperations for bleeding (4{\%}). Actuarial survival at 5, 10, 15, and 20 years was 93{\%} (95{\%} confidence interval [CI] = 88{\%} to 97{\%}), 79{\%} (95{\%} CI = 71{\%} to 87{\%}), 67{\%} (95{\%} CI = 57{\%} to 79{\%}), and 52{\%} (95{\%} CI = 36{\%} to 69{\%}), respectively. Freedom from reoperation was 72{\%} (95{\%} CI = 54{\%} to 86{\%}) at 20 years. Complications with anticoagulation occurred in 29 patients; with valve thrombosis, in 2; and with hemorrhage, in 27 (4 life threatening and 23 minor). Freedom from thromboembolism was 91{\%} (95{\%} CI = 77{\%} to 98{\%}) at 20 years. Freedom from endocarditis was 99{\%} (95{\%} CI = 92{\%} to 100{\%}) at 20 years. Multivariate analysis revealed preoperative mitral valve regurgitation (+3 to 4) and older age to be significant predictors of late death (P≤0.005), and Marfan syndrome, initial valve-preserving aortic root reconstruction, and need for a concomitant procedure at initial operation to be significant predictors of the need for reoperation (P-≤0.01). Conclusions-Aortic root replacement for aortic root aneurysms can be done with low morbidity and mortality. Composite valve conduit reconstruction resulted in a durable result. There were few serious complications related to the need for long-term anticoagulation or a prosthetic valve. Reoperation was most commonly required because of failure of the aortic valve when a valve-preserving aortic root reconstruction was performed or for other cardiac or aortic disease elsewhere.",
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T2 - A 30-year experience

AU - Zehr, Kenton J.

AU - Orszulak, Thomas A.

AU - Mullany, Charles J.

AU - Matloobi, Alireza

AU - Daly, Richard C.

AU - Dearani, Joseph A.

AU - Sundt, Thoralf M.

AU - Puga, Francisco J.

AU - Danielson, Gordon K.

AU - Schaff, Hartzell V

PY - 2004/9/14

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N2 - Background-This study evaluated long-term results of aortic root replacement and valve-preserving aortic root reconstruction for patients with aneurysms involving the aortic root. Methods and Results-Two-hundred three patients aged 53±16 years (mean±SD; 153 male, 50 female) underwent elective or urgent aortic root surgery from 1971 to 2000 for an aortic root aneurysm: 149 patients underwent a composite valve conduit reconstruction, and 54 patients underwent valve-preserving aortic root reconstruction. Fifty patients had Marfan syndrome. In-hospital and 30-day mortality was 4.0% (8/203) overall: for a composite valve conduit procedure, the corresponding value was 4.0% (6/149) and for valve-preserving procedure, 3.7% (2/54) (P=NS). Morbidity included 3 strokes (1%), 10 perioperative myocardial infarctions (5%), and 8 reoperations for bleeding (4%). Actuarial survival at 5, 10, 15, and 20 years was 93% (95% confidence interval [CI] = 88% to 97%), 79% (95% CI = 71% to 87%), 67% (95% CI = 57% to 79%), and 52% (95% CI = 36% to 69%), respectively. Freedom from reoperation was 72% (95% CI = 54% to 86%) at 20 years. Complications with anticoagulation occurred in 29 patients; with valve thrombosis, in 2; and with hemorrhage, in 27 (4 life threatening and 23 minor). Freedom from thromboembolism was 91% (95% CI = 77% to 98%) at 20 years. Freedom from endocarditis was 99% (95% CI = 92% to 100%) at 20 years. Multivariate analysis revealed preoperative mitral valve regurgitation (+3 to 4) and older age to be significant predictors of late death (P≤0.005), and Marfan syndrome, initial valve-preserving aortic root reconstruction, and need for a concomitant procedure at initial operation to be significant predictors of the need for reoperation (P-≤0.01). Conclusions-Aortic root replacement for aortic root aneurysms can be done with low morbidity and mortality. Composite valve conduit reconstruction resulted in a durable result. There were few serious complications related to the need for long-term anticoagulation or a prosthetic valve. Reoperation was most commonly required because of failure of the aortic valve when a valve-preserving aortic root reconstruction was performed or for other cardiac or aortic disease elsewhere.

AB - Background-This study evaluated long-term results of aortic root replacement and valve-preserving aortic root reconstruction for patients with aneurysms involving the aortic root. Methods and Results-Two-hundred three patients aged 53±16 years (mean±SD; 153 male, 50 female) underwent elective or urgent aortic root surgery from 1971 to 2000 for an aortic root aneurysm: 149 patients underwent a composite valve conduit reconstruction, and 54 patients underwent valve-preserving aortic root reconstruction. Fifty patients had Marfan syndrome. In-hospital and 30-day mortality was 4.0% (8/203) overall: for a composite valve conduit procedure, the corresponding value was 4.0% (6/149) and for valve-preserving procedure, 3.7% (2/54) (P=NS). Morbidity included 3 strokes (1%), 10 perioperative myocardial infarctions (5%), and 8 reoperations for bleeding (4%). Actuarial survival at 5, 10, 15, and 20 years was 93% (95% confidence interval [CI] = 88% to 97%), 79% (95% CI = 71% to 87%), 67% (95% CI = 57% to 79%), and 52% (95% CI = 36% to 69%), respectively. Freedom from reoperation was 72% (95% CI = 54% to 86%) at 20 years. Complications with anticoagulation occurred in 29 patients; with valve thrombosis, in 2; and with hemorrhage, in 27 (4 life threatening and 23 minor). Freedom from thromboembolism was 91% (95% CI = 77% to 98%) at 20 years. Freedom from endocarditis was 99% (95% CI = 92% to 100%) at 20 years. Multivariate analysis revealed preoperative mitral valve regurgitation (+3 to 4) and older age to be significant predictors of late death (P≤0.005), and Marfan syndrome, initial valve-preserving aortic root reconstruction, and need for a concomitant procedure at initial operation to be significant predictors of the need for reoperation (P-≤0.01). Conclusions-Aortic root replacement for aortic root aneurysms can be done with low morbidity and mortality. Composite valve conduit reconstruction resulted in a durable result. There were few serious complications related to the need for long-term anticoagulation or a prosthetic valve. Reoperation was most commonly required because of failure of the aortic valve when a valve-preserving aortic root reconstruction was performed or for other cardiac or aortic disease elsewhere.

KW - Aneurysm

KW - Aorta

KW - Surgery

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