Surgical consideration of aortitis involving the aortic root

Abstract

Most serious complications after aortic valve replacement (AVR) in Takayasu's and Behçet's diseases are repeated detachment of the prosthetic valve and formation of a false aneurysm. Therefore, special consideration of the surgical treatment of aortitis involving the aortic root is required. Fifteen patients (12 with Takayasu's disease and three with Behçet's disease) underwent various surgical procedures, depending on the pathological changes in the aortic valve and the aortic root and on the degree of involvement of the coronary artery. Group 1 patients had coronary artery involvement alone and underwent coronary artery bypass grafting (CABG) (n = 3); group 2 patients had aortic regurgitation with an intact coronary artery and underwent AVR or a modified Bentall procedure (n = 7); and group 3 patients had aortic regurgitation with coronary artery involvement and underwent AVR, a modified Bentall procedure, or translocation with CABG (n = 5). A prosthetic valve or composite graft with a Teflon felt flange at the sewing ring was fabricated during surgery by exact measurement of the sizes of the aortic annulus and distal aorta and treatment with fibrin glue before insertion. The double-fixation method with reinforcement by a Teflon felt strip was employed for anastomosis of the flanged prosthesis. The button-shaped coronary ostium was directly anastomosed to the composite graft. One patient required translocation with CABG because of a deteriorated annulus. There were no operative or hospital deaths. One patient died of a brain abscess at 6 months after surgery, and another patient who underwent CABG required CABG reoperation due to graft occlusion. We recommend postoperative steroid therapy in patients who are diagnosed as being in the active stage of the disease until inflammatory signs disappear.