Composite valve-graft replacement of aortic root using separate Dacron tube for coronary artery reattachment.

Traditional techniques of aortic root replacement have consisted of separate valve and graft replacement or use of a composite valve graft. These methods have been associated with problems including hemostasis, suture line disruption, and pseudoaneurysm development. They have had limited application in patients without sinus segment enlargement and acute aortic dissection. Between May 21, 1986, and September 7, 1988, 90 patients (73 male and 17 female) underwent replacement of the aortic valve and ascending aorta using a composite valve graft with reattachment of the coronary ostia using a separate, smaller (10 mm) Dacron tube graft. Aortic root replacement was done alone in 41 patients (46%), in association with a concomitant cardiac procedure in 26 patients (29%), and in 23 patients (26%) undergoing cardiac reoperation with and without a concomitant procedure. Aortic arch replacement was required in 25 patients (28%). Profound hypothermia and circulatory arrest were employed in 29 patients (32%). Early survival was 91% (82/90), and there were 4 late deaths. The procedure was found to be hemostatic (only 4 patients [4%] required reexploration for hemorrhage) and durable (no reoperation for pseudoaneurysm formation was necessary).