Long term results of aortic root replacement with aortic allograft in patients with dissection of the ascending aortic wall

Fourthy pts with aortic aneurysm and dissection of aortic wall who underwent aortic allograft root replacement with reimplantation of coronary arteries were observed. All pts had dissection of the ascending aorta: 16 pts type I and 24 pts type II according to DeBakey classification ( 13 pts with Marfan Syndrome).28 pts had chronic dissection and 12 had acute dissection of the aortic wail. In 32 pts aortic valves were incompetent,8 pts had infective endocarditis. In 6 pts the angiographic studies were performed. Mean follow-up period has been 104+/-48.1 months. The early mortality was 17.5%(7 pts), late mortality 15.0% ( 6 pts), reoperations 16.5%(7 pts) for allograft incompetence. Mean time to reoperations was 84,4+/-28.1 month (range 1 to 147 months). Probability of survival after 17 years of follow up is about 63% and is the lowest for pts with Marfan syndrome and aortic dissection type I DeBakey (about 32%). Echocardiographic study of the remaining ( 26 pts) with intact allograft showed thickening of the leaflets in 21 pts ( 80.8%) and calcifications in 6 pts ( 23.1%). Doppler results - mean systolic gradient 5.1 +/- 2.9 mmHg( range I to 17 mmHg), aortic regurgitation grade I to II in all pts. Air of these pts are in NYHA functional class I or II.