Early results of Bentall aortic root replacement for ascending aortic aneurism

Aim: The aim of this study was twofold: i) to assess the early and long-term outcomes in patients undergoing aortic root replacement (ARR) with a composite graft (CG) and; ii) to identify the predictors for poor overall survival in this group of patients. Methods: Between March 2006 and September 2014, 48 patients underwent ARR with a CG. Mean age was 51±12 years (range: 26-77 years). Atherosclerotic aneurysm was the most frequent cause of aortic disease with 38 (76.8%) patients, followed by type A acute aortic dissection (10, or 20.3%). Marfan s syndrome was present in 2 (4.2%) patients. Duration of follow-up ranged from 38±29 months. Results: The overall hospital mortality was 3 (6.3%) patients. One of the fatal cases had a cerebrovascular accident, one died from postoperative acute myocardial infarction and one from postoperative bleeding. The most frequently found complication resulted to be atrial fibrilation in 11 (22.9%) patients, renal failure in 6 (12%) patients and bleeding in 5 (10.4%) patients. The incidence of perioperative myocardial infarction, neurological complications, respiratory complications, renal failure and coagulopathy incidence were significantly higher in patients with cardiopulmonary bypass (CPB) time 155 min, CA 25 min, and total aortic arch replacement. Survival rate in patients with aortic dissection was significantly lower compared to non-dissection counterparts (P=0.022). The multivariate analysis revealed the aortic dissection (P=0.03), age >65 years (P=0.014), associated coronary artery disease (P=0.002), and total arch reconstruction (P=0.003) as strong predictors for poor overall survival in patients undergoing ARR. Conclusions: The ARR with a CG offers acceptable early and long-term outcome. The predictors for poor overall survival in patients undergoing ARR seems to be preoperative aortic dissection extended into the aortic arch, older age, depressed left ventricular function and associated coronary artery disease.