gms | German Medical Science

Introduction: Aortic valve pathologies in combination with dilatation of the ascending aorta and maintained sinutubular junction are frequently seen. We compared clinical and long-term results after (1) combined replacement of the aortic valve and supracoronary ascending aorta (AV SCAR) with the (2) Bentall-technique.

Material and methods: 197 consecutive patients with combined aortic valve pathology and dilatation of the ascending aorta were included. Reoperation, endocarditis, combination with CABG or other valves aswell as dissecting aneurysms were excluded. Bentall-procedure was performed in 86 cases, AV SCAR in 111 patients. Follow-up was complete with a total of 749 patient-years.

Results: Bentall-group was significantly younger (58.6±1.2 vs. 66.0±1.0 years; p<0.01), suffered less frequently from extracardiac arteropathy (67.4% vs. 82.9%; p=0.01), diabetes (8.1% vs. 18.0%; p=0.03) and renal impairment (16.3% vs. 33.3%; p<0.01). Thus, logistic euroSCORE was significantly higher in AV SCAR-patients (20.8±1.1% vs. 14.1±1.3%; p<0.01). Procedure- and x-clamp-time were significantly shorter in AV SCAR-group (p=0.05). Postoperative course and clinical morbidity concerning ventilation time, bleeding, stroke, renal failure was comparable between both groups. Hospital mortality was 2.3% for Bentall and 3.6% for AV SCAR-group (p=0.6). Overall mortality was 4.0% for Bentall and 5.4% for AV SCAR-group (p=0.7). Freedom from reoperation was 98.5% and did not differ significantly between both groups.

Conclusion: The decision for Bentall-procedure was predominatly made in younger and healthier patients. Anyhow, AV SCAR provided in the older and even worser patient group comparable results and shorter procedure-times. AV SCAR might be sufficient in patients suffering from aortic valve pathologies in combination with dilatation of the ascending aorta and maintained sinutubular junction.