Use of the intraluminal vascular prosthesis for the repair of aneurysm of the ascending aorta.
ABSTRACT We present the case of a 49-year-old patient with aneurysm of the ascending aorta as well as mitral and aortic valvar insufficiency treated surgically. Preoperatively the patient was in NYHA functional class IV. We implanted mitral and aortic valvar prostheses and an intraluminal vascular graft in the ascending aorta above the coronary ostia. The postoperative course was uneventful. Five months after the operation the patient is in functional class II.
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ABSTRACT: The long-term outcome of sutureless intraluminal graft insertion remains unclarified. Therefore, we reviewed the late surgical outcomes of patients who underwent this procedure for acute type A dissection. Between March 1990 and May 2000, 80 patients aged from 36 to 92 years underwent isolated replacement of the ascending aorta for type A acute aortic dissection. The surgical procedures performed were replacement with an intraluminal sutureless graft in 18 patients (group 1) and suturing of the aorta with a conventional Dacron prosthesis in 62 patients (group 2). The cross-clamp, extracorporeal circulation, circulatory arrest, and operation times were significantly shorter in group 1 than in group 2, and the amount of total blood transfusion was also significantly less in group 1 than in group 2. The hospital mortality rates were 11.1% (2/18) in group 1 and 9.7% (6/62) in group 2 (P > 0.999). The 5-year actuarial survival rates (including operative mortality) were 71% ± 11% in group 1 and 77% ± 9% in group 2 (P = 0.268). The event-free survival rates at 5 years were 80% ± 10% in group 1, and 67% ± 13% in group 2 (P = 0.780). Regarding graft-related complications, long-term follow-up revealed one graft-related death and one reoperation in group 1 (12.5%), and no graft-related complications in group 2 (0%) (P = 0.047). In conclusion, intraluminal sutureless grafts required less blood transfusion, and shorter cross-clamp, extracorporeal circulation, circulatory arrest, and surgery times. However, the procedure did not improve the hospital mortality or long-term outcome. In fact, the rate of graft-related complications was significantly higher in the intraluminal sutureless group than in the sutured group. Therefore, the intraluminal graft insertion technique should be used only under exceptional circumstances.Surgery Today 09/2001; 31(10):866-871. · 0.96 Impact Factor