Summary
This paper reviews the early and late results of 36 operations for aneurysms of the
ascending aorta. Cystic medial necrosis was the predominant cause of aneurysm formation
(56 %), followed by arteriosclerosis (25 %), previous aortotomy (11 %) and syphilitic
aortitis (8 %). Dissection was encountered in 42 %. The ascending aorta was replaced
by a tubular Dacron graft in 26 patients, whereas 10 underwent aneurysmorrhaphy. Additional
procedures were aortic valve replacement (27), resuspension of the aortic commissures
(4) and coronary ostial implantation into sinus-shaped composite Dacron graft (4).
Hospital mortality (0–18 days) was 8/36 patients (22 %), but higher with cystic medial
necrosis (30 %), dissection (33 %), duration of ECC > 180 minutes (38 %), graft replacement
(44 %), emergency operation (45 %) and heart volume > 900 ml/m2 BSA (50 %). Late mortality (average 3 years) was 29 %, but higher with cystic medial
necrosis (33 %), following aortic valve replacement (36 %) and during anticoagulation
(47 %). Late cumulative survival (average 3 years) was 47 % for the entire series,
but only 33 % in the presence of cystic medial necrosis.
The poor overall prognosis for patients with cystic medial degeneration was closely
related to a high incidence of fatal anastomotic complications and late deaths from
cerebral haemorrhage during anticoagulation. Radical exclusion of the diseased aortic
wall and omission of long-term anticoagulation are therefore desirable in order to
lower the mortality rate. Surgery concerns the aneurysm per se, the aortic incompetence
and the coronary ostia. The sinus-shaped composite graft with a Björk-Shiley prosthesis
at its base appears to be a promising device for such a procedure, which should be
performed electively, following early diagnosis in order to prevent dissection and
emergeny operations.
Key-Words:
Aortic aneurysm, ascending - Surgical treatment - Aortic valve replacement - Aortic
aneurysmorrhaphy
