Elsevier

The Annals of Thoracic Surgery

Volume 90, Issue 6, December 2010, Pages 1869-1875
The Annals of Thoracic Surgery

Original article
Adult cardiac
Quality of Life After Aortic Root Surgery: Reimplantation Technique Versus Composite Replacement

https://doi.org/10.1016/j.athoracsur.2010.07.067Get rights and content

Background

Recent studies indicate the safety of the aortic valve reimplantation technique (David operation) in the long-term follow-up. The aim of this study was to compare the results of the David operation with those of the aortic composite replacement procedure, with the focus on quality of life (QoL).

Methods

Within a 6-year period, 143 patients received either an aortic composite replacement (composite group, n = 67) or the David-I operation (David group, n = 76). The QoL of 108 patients (87% of the living patients) was evaluated postoperatively by the 36-Item Short Form Health Survey. A subgroup analysis of QoL excluded patients with aortic stenosis and type A acute aortic dissection.

Results

Hospital survival rates (89.6% versus 97.4%, p = 0.102), as well as actuarial 1-year survival rate (86.6% versus 91.9%) and 3-year survival rate (81.1% versus 91.9%) proved more successful among the David group. Incidences of serious adverse events during the follow-up period (10.8% versus 28.3%, p = 0.008) were higher for patients of the composite group. The QoL was found to be compromised for patients of the composite group, in relation to all criteria outlined in the 36-Item Short Form Health Survey. Subgroup analysis without patients with dissection and aortic stenosis demonstrated a significantly better postoperative QoL for patients of the David group. Patients belonging to the composite group were more frequently compromised by prosthetic valve noise (p < 0.001).

Conclusions

This study demonstrates the superiority of the aortic valve reimplantation compared with the aortic composite replacement, regarding both clinical outcome and postoperative QoL.

Section snippets

Patients and Methods

This study was approved by the Ethics Committee of the Friedrich-Schiller University. All patients were asked to participate at this study at time of the QoL survey.

From September 1999 to December 2005, a total of 143 consecutive patients underwent the aortic root operation. Two types of aortic root operations were performed. In the composite group, 67 patients received a total replacement of the aortic root using mechanical conduit prosthesis (CarboSeal; Sorin, Munchen, Germany). In the David

Clinical Outcome

Nine patients died during the hospital follow-up (6.3%), 6 after elective operation and 3 after acute aortic dissection repair. Consecutively, the hospital survival rates were recorded at 97.4% (74 of 76 patients) for the David group and 89.6% (60 of 67 patients) for the composite group (p = 0.102). Causes of death include bowel ischemia (2), systemic inflammatory response syndrome with consecutive multiple organ failure (2), severe stroke (2), and rupture of the descending aorta, cardiac low

Comment

Aortic valve-sparing operations have been developing rapidly over recent years. Reported hospital mortality ranges from 0% to approximately 10%, depending on incidence of acute type A aortic dissection, emergency, mean age, and Marfan's syndrome [3, 9, 10, 11, 12]. Correspondingly, 1-year survival rates of more than 90%, and 10-year survival rates of approximately 80%, can be achieved [3, 9, 12]. The longevity of reconstruction results are reported as extremely stable, offering a freedom from

References (15)

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