Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 1979 Oct;34(5):599–605. doi: 10.1136/thx.34.5.599

Surgery of the ascending aorta: five years' experience at a regional cardiac centre.

P G Reasbeck, J L Monro, J K Ross, N Conway, A M Johnson
PMCID: PMC471132  PMID: 515980

Abstract

Between 1972 and 1978, 31 patients underwent replacement of the ascending aorta, with or without aortic valve surgery, at the Wessex Regional Cardiac Centre. The commonest indications for operation were aneurysmal dilatation of the ascending aorta causing aortic regurgitation and acute dissection of the ascending aorta. Eleven of the 31 patients had features of Marfan's syndrome. The overall hospital mortality was 19.4%, a figure comparable with those reported in other series; ventricular failure secondary to ischaemia during operation was the commonest cause of death. The long-term symptomatic results were excellent, except in the two patients who underwent resuspension of the aortic valve for aortic regurgiation associated with acute dissections. For aneurysms of the ascending aorta with associated aortic regurgitation, replacement of the valve and ascending aorta with a combined valve prosthesis and synthetic tube graft, with reimplantation of the coronary ostia, is the procedure of choice if the aortic valve ring is diseased. Experience to date indicates that replacement of the ascending aorta and aortic valve with separate prostheses, leaving the coronary ostia undisturbed, is a satisfactory alternative provided the aortic annulus is of suitable size and quality; this is more likely to be the case in dissections than in aneurysmal dilatation of the ascending aorta. Replacement of the ascending aorta may also be indicated in some cases of dilatation of the ascending aorta secondary to aortic valve disease if the aortic wall is unusually thin.

Full text

PDF
599

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Appelbaum A., Karp R. B., Kirklin J. W. Ascending vs descending aortic dissections. Ann Surg. 1976 Mar;183(3):296–300. doi: 10.1097/00000658-197603000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. BAHNSON H. T., NELSON A. R. Cystic medial necrosis as a cause of localized aortic aneurysms amenable to surgical treatment. Ann Surg. 1956 Oct;144(4):519–529. doi: 10.1097/00000658-195610000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. BAHNSON H. T., SPENCER F. C. Excision of aneurysm of the ascending aorta with prosthetic replacement during cardiopulmonary bypass. Ann Surg. 1960 Jun;151:879–890. doi: 10.1097/00000658-196006000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bentall H., De Bono A. A technique for complete replacement of the ascending aorta. Thorax. 1968 Jul;23(4):338–339. doi: 10.1136/thx.23.4.338. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Blanco G., Adam A., Carlo V. A controlled surgical approach to annulo-aortic ectasia. Ann Surg. 1976 Feb;183(2):174–178. doi: 10.1097/00000658-197602000-00015. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Brooyn T., Frooysaker T., Hall K. V. Aneurysms of the ascending aorta with aortic valve incompetence. Scand J Thorac Cardiovasc Surg. 1977;11(3):221–223. [PubMed] [Google Scholar]
  7. Carey J. S., Skow J. R., Scott C. Retrograde aortic dissection during cardiopulmonary bypass: "nonoperative" management. Ann Thorac Surg. 1977 Jul;24(1):44–48. doi: 10.1016/s0003-4975(10)64570-5. [DOI] [PubMed] [Google Scholar]
  8. Crosby I. K., Ashcraft W. C., Reed W. A. Surgery of proximal aorta in Marfan's syndrome. J Thorac Cardiovasc Surg. 1973 Jul;66(1):75–81. [PubMed] [Google Scholar]
  9. DEBAKEY M. E., HENLY W. S., COOLEY D. A., MORRIS G. C., Jr, CRAWFORD E. S., BEALL A. C., Jr SURGICAL MANAGEMENT OF DISSECTING ANEURYSMS OF THE AORTA. J Thorac Cardiovasc Surg. 1965 Jan;49:130–149. [PubMed] [Google Scholar]
  10. Daily P. O., Trueblood H. W., Stinson E. B., Wuerflein R. D., Shumway N. E. Management of acute aortic dissections. Ann Thorac Surg. 1970 Sep;10(3):237–247. doi: 10.1016/s0003-4975(10)65594-4. [DOI] [PubMed] [Google Scholar]
  11. ELLIOTT D. P., ROE B. B. AORTIC DISSECTION DURING CARDIOPULMONARY BYPASS. J Thorac Cardiovasc Surg. 1965 Sep;50:357–363. [PubMed] [Google Scholar]
  12. ELLIS P. R., COOLEY D. A., DE BAKEY M. E. Clinical considerations and surgical treatment of annulo-aortic ectasia. Report of successful operation. J Thorac Cardiovasc Surg. 1961 Sep;42:363–370. [PubMed] [Google Scholar]
  13. Edwards W. S., Kerr A. R. A safer technique for replacement of the entire ascending aorta and aortic valve. J Thorac Cardiovasc Surg. 1970 Jun;59(6):837–839. [PubMed] [Google Scholar]
  14. Gerbode F., Semb G. S., Hill J. D., Kerth W. J. Aneurysms of the ascending aorta. A method of reconstructing the aortic root. Ann Thorac Surg. 1966 Jul;2(4):525–531. doi: 10.1016/s0003-4975(10)66612-x. [DOI] [PubMed] [Google Scholar]
  15. Hashimoto A., Kitamura N., Koyanagi H., Konno S. Surgical treatment of annulo-aortic ectasia. J Cardiovasc Surg (Torino) 1976 May-Jun;17(3):240–247. [PubMed] [Google Scholar]
  16. Helseth H. K., Haglin J. J., Stenlund R. R., Peterson C. R. Evaluation of composite graft replacement of the aortic root and ascending aorta. Ann Thorac Surg. 1974 Aug;18(2):138–141. doi: 10.1016/s0003-4975(10)64338-x. [DOI] [PubMed] [Google Scholar]
  17. Kay J. H., Dykstra P. C., Tsuji H. K. Retrograde ilioaortic dissection. A complication of common femoral artery perfusion during open heart surgery. Am J Surg. 1966 Mar;111(3):464–468. doi: 10.1016/s0002-9610(66)80027-2. [DOI] [PubMed] [Google Scholar]
  18. Lindsay J., Jr, Hurst J. W. Clinical features and prognosis in dissecting aneurysm of the aorta. A re-appraisal. Circulation. 1967 May;35(5):880–888. doi: 10.1161/01.cir.35.5.880. [DOI] [PubMed] [Google Scholar]
  19. MULLER W. H., Jr, DAMMANN J. F., Jr, WARREN W. D. Surgical correction of cardiovascular deformities in Marfan's syndrome. Ann Surg. 1960 Sep;152:506–517. [PMC free article] [PubMed] [Google Scholar]
  20. McKUSICK V. A. The cardiovascular aspects of Marfan's syndrome: a heritable disorder of connective tissue. Circulation. 1955 Mar;11(3):321–342. doi: 10.1161/01.cir.11.3.321. [DOI] [PubMed] [Google Scholar]
  21. ROARK J. W. The Marfan syndrome: report of one case with autopsy, special histological study, and review of the literature. AMA Arch Intern Med. 1959 Jan;103(1):123–132. doi: 10.1001/archinte.1959.00270010129017. [DOI] [PubMed] [Google Scholar]
  22. Seybold-Epting W., Meyer J., Hallman G. L., Cooley D. A. Surgical treatment of acute dissecting aneurysm of the ascending aorta. J Cardiovasc Surg (Torino) 1977 Jan-Feb;18(1):43–48. [PubMed] [Google Scholar]
  23. Singh M. P., Bentall H. H. Complete replacement of the ascending aorta and the aortic valve for the treatment of aortic aneurysm. J Thorac Cardiovasc Surg. 1972 Feb;63(2):218–225. [PubMed] [Google Scholar]
  24. Symbas P. N., Baldwin B. J., Silverman M. E., Galambos J. T. Marfan's syndrome with aneurysm of ascending aorta and aortic regurgitation. Surgical treatment and new histochemical observations. Am J Cardiol. 1970 Apr;25(4):483–489. doi: 10.1016/0002-9149(70)90018-4. [DOI] [PubMed] [Google Scholar]
  25. Taylor P. C., Effler D. B. Management of cannulation for cardiopulmonary bypass in patients with adult-acquired heart disease. Surg Clin North Am. 1975 Oct;55(5):1205–1215. doi: 10.1016/s0039-6109(16)40746-2. [DOI] [PubMed] [Google Scholar]
  26. WHEAT M. W., Jr, WILSON J. R., BARTLEY T. D. SUCCESSFUL REPLACEMENT OF THE ENTIRE ASCENDING AORTA AND AORTIC VALVE. JAMA. 1964 May 25;188:717–719. doi: 10.1001/jama.1964.03060340015004. [DOI] [PubMed] [Google Scholar]
  27. Wheat M. W., Jr, Harris P. D., Malm J. R., Kaiser G., Bowman F. O., Jr, Palmer R. F. Acute dissecting aneurysms of the aorta. Treatment of results in 64 patients. J Thorac Cardiovasc Surg. 1969 Sep;58(3):344–351. [PubMed] [Google Scholar]
  28. Yacoub M., Gula G., McKay R., Pomerance A. Proceedings: Surgical treatment of aneurysms of ascending aorta. Br Heart J. 1976 Aug;38(8):874–874. [PubMed] [Google Scholar]
  29. Zingone B., Vaccari M., Camerini F. Surgical treatment of aortic valve insufficiency due to annulo-aortic ectasia. J Cardiovasc Surg (Torino) 1977 Nov-Dec;18(6):581–589. [PubMed] [Google Scholar]
  30. Zubiate P., Kay J. H. Surgical treatment of aneurysm of the ascending aorta with aortic insufficiency and marked displacement of the coronary ostia. J Thorac Cardiovasc Surg. 1976 Mar;71(3):415–421. [PubMed] [Google Scholar]
  31. d'Allaines C., Blondeau P., Piwnica A., Carpentier A., Soyer R., Deloche A., Farge C., Relland J. Y., Dubost C. Surgery for aortic dissection: 53 operated cases with 32 in the acute phase. J Cardiovasc Surg (Torino) 1977 May-Jun;18(3):261–266. [PubMed] [Google Scholar]
  32. indsay J., Jr, Hurst J. W. Drug therapy of dissecting aortic aneurysms. Some reservations. Circulation. 1968 Feb;37(2):216–219. doi: 10.1161/01.cir.37.2.216. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES