Impact of valve type on long-term results after combined repair of aortic aneurysm and the aortic valve –45 years experiance

Objectives: Reoperations after repair of the ascending aorta deemed to be challanging. This study investigated on long-term outcome after surgical treatment of the aorta with special focus on performance of valve type.

Methods: From 19766 to 2005, 602 patients were treated for aortic valve disease and ascending aortic aneurysm. Aortic valve replacement was performed with 303 (50.3%) mechanical HV, 223 (37.0%) biological HV and 76 (12.7%) homografts. Operative technique for aortic surgery was in 39% valve replacement and supracoronary graft, in 48.3% composite graft and in 12.7% homograft plus ascending aortic graft. Extended surgery, including the aortic arch or more segments, were performed in 13%.

Results: Cumulative survival was 89%, 81%, 70%, and 57% and 45% at 1, 5, 10, 15 and 20 years, respectively. During follow-up, 98 pts needed at least one reoperation. Reoperations were necessary in 13% after biological HV implantation, in 15% after mechanical HV replacement and in 17% when Homograft was implanted. There were no significant difference regarding type of HV prosthesis and reoperation. Multivariate analysis did not reveal the type of valve prosthesis (e.g. bioprosthesis or homograft) as significant determinant for overall survival (multivariate p=0.26; univariate p<0.001)). Operative technique for replacement of the ascending aorta did not reach statistical significance as independent risk-factor for long-term survival. Extended surgery to the arch, age, Marfan-Syndrom, poor clinical status, op-time, acute dissection, surgery before 1985, emergency operation were significant risk factors for mortality (all p<0.01).

Conclusions: Type of valve prosthesis had no negative impact on survival after aortic surgery.