[THe surgical treatment of aneurysmatic lesions of the ascending aorta: the immediate and long-term results in 40 patients]

From January 1981 to January 1991, 40 patients underwent operation for acute ascending aorta dissection (AAD, 14 patients), chronic ascending aorta dissection (CAD, 9 patients) or aortic ectasia (AE, 17 patients), with simultaneous aortic valve replacement in 30 cases (75\%). Average age was 54 years with a 3:1 M/F ratio. In 20 cases (50\%) a composite graft bearing a mechanical bileaflet valve was inserted with coronary artery reattachment (Bentall operation). In 16 cases (40\%) the ascending aorta was replaced by a woven dacron graft alone (7 cases) or associated with aortic valve substitution (7 cases) or resuspension (2 cases). In 1 case (2.5\%) a sutureless ring graft replacement of ascending aorta was carried out and 3 patients (7.5\%) underwent aortoplasty with aortic valve substitution. Postoperative mortality rate was 21\% for AAD group, 11\% for CAD group and 6\% for AE group. Non-fatal postoperative complications developed in 36\% of AAD patients and in 78\% and 29\% of CAD and AE patients respectively. These complications occurred in 45\% of patients who underwent Bentall operation, in 44\% of those who underwent ascending aorta replacement associated with aortic substitution or resuspension, and in 14\% of those operated of simple ascending aorta replacement. Average follow-up was 41.6 months (range 1.7-107.4 months). During this period 5 deaths occurred for a long-term mortality rate of 14.2\%. Out of 30 survivors 21 (70\%) underwent CT-study to evaluate the natural course of the false channel and the risk of redissection or late aneurysm formation.(ABSTRACT TRUNCATED AT 250 WORDS)