COMPOSITE VALVE GRAFT REPLACEMENT OF THE ASCENDING AORTA AND THE AORTIC-VALVE BY A MODIFIED BUTTON TECHNIQUE - THE INFLUENCE OF AORTIC PATHOLOGY ON EARLY MORTALITY AND LATE SURVIVAL

被引：4

作者：

BIGLIOLI, P ^{[1
]}

SALA, A ^{[1
]}

SPIRITO, R ^{[1
]}

PAROLARI, A ^{[1
]}

AGRIFOGLIO, M ^{[1
]}

ALAMANNI, F ^{[1
]}

HUANG, F ^{[1
]}

GEROMETTA, P ^{[1
]}

ARENA, V ^{[1
]}

机构：

[1] UNIV MILAN,IRCCS,FDN MONZINO I,CTR CARDIOL,DEPT CARDIAC SURG,I-20138 MILAN,ITALY

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 1995年 / 9卷 / 09期

关键词：

ASCENDING AORTA; COMPOSITE GRAFT VALVE REPLACEMENT; RISK FACTORS SURVIVAL; STATISTICAL ANALYSIS;

D O I：

10.1016/S1010-7940(95)80047-6

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

The risk factors for in-hospital mortality and mid-term survival in patients undergoing composite graft replacement of the aortic root with reimplant of coronary arteries by a modified button technique were evaluated with special emphasis on the underlying aortic pathology. Between 1985 and 1993 74 patients underwent replacement of the ascending aorta and the aortic valve following a modified button technique. The patients were divided into three groups according to aortic pathology: annuloaortic ectasia (43, 58%), type A dissection (18, 24%), and miscellaneous (13, 18%). In-hospital mortality rates were 4,7%, 33,3% and 23,1%, respectively (P = 0.011). Univariate analysis showed that aortic pathology, NYHA class, emergency operation, redo operation, acute aortic dissection, preoperative cardiogenic shock, preoperative cardiac tamponade, longer cardiopulmonary bypass (CPB) and aortic cross-clamp times, and the need of femoral vein or femoral artery cannulation at intervention had univariate influence on in-hospital mortality. Multivariable stepwise logistic regression analysis identified CPB time odds ratio (OR)= 1.021/min, P = 0.007), the need of femoral vein cannulation at intervention (OR = 4.85, P = 0.008) and preoperative cardiac tamponade (OR = 3.11, P = 0.07) as independent predictors of in-hospital death. Follow-up ranged from 1 to 98 months (mean 39 +/- 30 months), with an actuarial survival rate of 75 +/- 9%, 52 +/- 13% and 67 +/- 14% at 5 years in annuloaortic ectasia, type A dissection, and miscellaneous patients, respectively (P = 0.18); when survival was evaluated in hospital survivors only, Kaplan-Meier survival rates were 77 +/- 9%, 79 +/- 14% and 89 +/- 10% at 5 years (P = 0.87). Comparing survival of annuloaortic ectasia patients (5-year survival 75 +/- 9%) versus survival of all other patients pooled together (5-year survival 55 +/- 11%), there was a statistically significant difference (P < 0.05); such a difference was no longer significant when comparing hospital survivors alone (5-year survival rate 77 +/- 9% annulo-aortic ectasia patients vs 79 +/- 12% all other patients P = 0.61). Although aortic root replacement carries higher in-hospital mortality in some high-risk subgroups of patients, mid-term survival seems to be less affected by aortic pathology; high-risk patients are expected to have an out-hospital outcome comparable to the low-risk ones.

引用

页码：483 / 490

页数：8

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