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. 2017 Oct 1;5(5):139-147.
doi: 10.12945/j.aorta.2017.17.044. eCollection 2017 Oct.

Surgical Treatment of Annuloaortic Ectasia - Replace or Repair?

Andrea De Martino  1 , Federico Del Re  1 , Stefania Blasi  1 , Michele Celiento  1 , Giacomo Ravenni  1 , Stefano Pratali  1 , Aldo D Milano  2 , Uberto Bortolotti  1
Affiliations

Surgical Treatment of Annuloaortic Ectasia - Replace or Repair?

Andrea De Martino et al. Aorta (Stamford). .

Abstract

Background: Patients with annuloaortic ectasia may be surgically treated with modified Bentall or David I valve-sparing procedures. Here, we compared the long-term results of these procedures.

Methods: A total of 181 patients with annuloaortic ectasia underwent modified Bentall (102 patients, Group 1) or David I (79 patients, Group 2) procedures from 1994 to 2015. Mean age was 62 ± 11 years in Group 1 and 64 ± 16 years in Group 2. Group 1 patients were in poorer health, with a lower ejection fraction and higher functional class.

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

Conclusions: The modified Bentall and David I procedures showed excellent early and late results. The modified Bentall procedure with a mechanical conduit was associated with thromboembolic and hemorrhagic complications, whereas the David I procedure was associated with unexplained occurrences of endocarditis. Thus, the David I procedure appears to be safe, reproducible, and capable of achieving stable aortic valve repair and is therefore our currently preferred solution for patients with annuloaortic ectasia. However, the much shorter follow-up for David I patients limits the strength of our comparison between the two techniques.

Keywords: Aorta; Aortic aneurysm; Aortic valve.

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Figures

Figure 1.
Figure 1.
Actuarial survival after the modified Bentall and David I aortic valve-sparing procedures. Numbers on the horizontal axis indicate patients at risk.
Figure 2.
Figure 2.
Actuarial freedom from thromboembolic complications (left panel) and anticoagulant-related hemorrhage (right panel).
Figure 3.
Figure 3.
Actuarial freedom from reoperation for all causes (left panel) and procedure-related reoperations (PRR, right panel).
Figure 4.
Figure 4.
Graphic representation of preoperative aortic incompetence grade (Panel A) and aortic incompetence grade at last post-repair follow-up (Panel B).
See this image and copyright information in PMC

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