Aortic Root Replacement with Composite Graft: Experience in 95 Patients

Between January 1994 and June 1998, 95 patients with a mean age of 40.6 years (range, 23 to 69 years) underwent aortic root replacement with composite grafts. The operations were performed under hypothermia and cardiopulmonary bypass. In dissecting aortic aneurysm or aneurysms involving the aortic arch, selective cerebral perfusion via the right subclavian artery was employed, with additional femoral arterial cannulation if necessary. Combined procedures included partial arch replacement (6), elephant trunk technique (2), and mitral valve replacement (2). The mean duration of aortic crossclamping was 74.3 ± 17.9 min (42 to 133 min) and the mean duration of cardiopulmonary bypass was 117.8 ± 28.6 min (60 to 232 min). The hospital mortality was 1.1% (1 patient) and there was one late death. Complications comprised reexploration for bleeding (2), pericardial effusion (2), cerebral infarction (1), pleural effusion (1), and pneumothorax (1). Blood transfusion was not needed in 8 patients. Hemorrhage was the most dangerous complication. Suitable operative methods and improved techniques are the keys to successful aortic root replacement.