Long-Term Outcome of Composite Valve Graft Replacement in Patients with Aortic Valve Disease and Aneurysm of the Ascending Aorta

The purpose of this study was to evaluate the clinical outcome of composite valve graft replacement in 193 patients with aortic valve disease and aneurysm of the ascending aorta from January 1980 to June 1999. The clinical outcome was compared between the patients diagnosed with Marfan syndrome (M) and those without Marfan syndrome (nonM), between those with aortic dissection (DA) and without dissection (nonDA), between two different techniques for coronary artery reconstruction (modified Bentall (mB) and modified Piehler (mP)), and between the time of operation (1980～1989 and 1990～1999). Actuarial survival (AS), freedom from cardiac event (EF), and freedom from reoperation (RF) were compared between each subgroup by Cox-Mantel statistical analysis. Long-term outcome of this procedure was almost satisfactory, with AS of 71.5 ± 4.4% at 10 years and RF of 76.5 ± 4.4% at 10 years. EF and RF were significantly lower in M group and DA group than in nonM and nonDA group. There was no difference between mB group and mP group. Also, AS was significantly higher in the latter 10 years compared with the former 10 years. It was concluded that the improvement of perioperative management and the proper selection of the technique for coronary artery reconstruction could have improved the clinical outcome. In patients with Marfan syndrome or aortic dissection, there still remains a higher risk of cardiac accident and future reoperation. Extensive aortic reconstruction or staged operation should be perform in such patients