Surgical Treatments For Aortic Root

Propose:This article is aim to focus on the surgical treatments of aortic diseases, especially ascending aortic aneurysm and acute type A aortic dissection, to make the patient specific surgical treatments. Besides this, we reported our center experience about the modified-Bentall procedure to treat such two kinds of patients.Methods:We scanned the database of Pubmed, use "ascending aorta aneurysm", "aortic dissection", "aortic root", "surgical treatment" as key words. We searched 1479 related articles,634 articles about aneurysm and 845 articles about dissection. We chose 148 of them by reading the titles and abstracts, then we discussed about the surgical treatments of aortic root based on them. Apart from these work, we did a retrospective study about the clinical outcome of ascending aorta aneurysm (AA group) and acute type A aortic dissection (AAAD group) by doing the modified-Bentall procedure. Clinical information was based on database of our center.Results:The mean age of AAAD group was 47.3±12.0 yrs and of AA group was 55.5±13.2 yrs. Most of the patients were male patients. There were about 45% of patients had a long history of hypertension. The basic status of AAAD group patients was really poor; some of them were suffered from malperfusion syndrome, especially the malperfusion of coronary artery. Among patients of AA group, cardiac dysfunction was common; mean LVEF was about 46.6±8.9%.47.2% of patients in AA group had severe aortic valve insufficiency, and most of them had more than two valve dysfunction.30-day mortality of AA group was 0, and of AAAD group was 14.3%.The total in-hospital mortality was about 5.5%. Main reasons of death were circulatory failure and MODS. During the follow up, there were 7 deaths in AAAD group and 2 deaths in AA group. One-year and three-year survival rate of AAAD group is 90.9% and 89.4%, of AA group is 99.2% and 98.4%. There was no aortic root related re-operation of all patients.8 patients of AAAD group and 3 patients of AA group were found bypass from aortic root to right atrium by CT scan after operation. Till one year still 4 of AAAD group and 2 of AA group had the bypass. However, none of them had obviously clinical complaint.Conclusion:Our study reported the clinical outcome of modified-Bentall procedure in 5 years. The mortality rate was low in selective operation, and the follow up results were really good. Such procedure was an alternative choice for those patients whose valve couldn’t be repaired and need to replace the aortic root.