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Guido Michielon, Carlo Valfre. Cardiac Surgery Department,
Treviso, Italy.
Objective: Midterm results of a modified Button-Bentall
operation (mB) specifically designed to incorporate any type of
prosthetic valve in composite conduit aortic root replacement.
Methods: Between 1991 and 2000, 131 pts underwent
mB for annuloaortic ectasia (71), type A dissection (31) or aortic
aneurysm without dissection (29). Thirty-three were emergencies
(25.3%). Forty-eight bioprostheses (Group-1) and 83 bileaflet
mechanical prostheses (Group-2) were implanted. Group-1 mean
age was 66.9 yrs vs 51.5 yrs in Group-2 (p=0.001) Composite-conduit
creation occurred during proximal suture-line construction as
a single step maneuver. Interrupted extracardiac polyester mattress
sutures sequentially entered the aortic annulus, the prosthetic
valve ring and the vascular graft, 7mm from its free edge. Running
monofilament suture-line secured haemostasis, buttressing aortic
remnants and graft edge. Coronary implantation was always accomplished
by button technique. Concomitant procedures were performed in
49 pts (37.4%).
Results: 30-day mortality was 5.3% (7 pts). Seven pts
(5.3%) required revision for proximal (1), coronary button (2)
or distal (4) anastomotic leakage. Three pts (2.3%) developed
perioperative non-fatal myocardial infarction. Kaplan Meier 9-year
survival is 91.5% with 86.6% reoperation freedom. According to
Cox proportional hazard, stratification of risk of death according
to prosthesis type, indicates previous operation (p=0.001) and
emergency (p=0.046) as independent predictors of hospital mortality.
Associated procedures to mB increased the risk of reoperation
(p=0.031).
Conclusions: MB was associated with low mortality,
excellent mid-term survival and reoperation freedom. Absence
of valve-to-graft tapering, reduced coronary button anastomosis
tension and prosthesis selection according to patient profile,
appear appealing advantages of mB.
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