Does Additional Aortic Procedure Carry a Higher Risk in Patients Undergoing Aortic Valve Replacement?

BACKGROUND: With growing attention to the aortopathy associated with aortic valve diseases, the number of candidates for accompanying ascending aorta and/or root replacement is increasing among the patients who require aortic valve replacement (AVR). However, such procedures have been considered more risky than AVR alone. This study aimed to compare the surgical outcome of isolated AVR and AVR combined with aortic procedures. MATERIALS AND METHODS: A total of 86 patients who underwent elective AVR between 2004 and June 2010 were divided into two groups: complex AVR (n=50, AVR with ascending aorta replacement in 24 and the Bentall procedure in 26) and simple AVR (n=36). Preoperative characteristics, surgical data, intra- and postoperative allogenic blood transfusion requirement, the postoperative clinical course, and major complications were retrospectively reviewed and compared. RESULTS: The preoperative mean logistic European System for Cardiac Operative Risk Evaluation (%) did not differ between the groups: 11.0±7.8% in the complex AVR group and 12.3±8.0% in the simple AVR group. Although complex AVR required longer cardiopulmonary bypass (152.4±52.6 minutes vs. 109.7±22.7 minutes, p=0.001), the quantity of allogenic blood products did not differ (13.4±14.7 units vs. 13.9±11.2 units). There was no mortality, mechanical circulatory support, stroke, or renal failure requiring hemodialysis/filtration. No difference was found in the incidence of bleeding (40% vs. 33.3%) which was defined as red blood cell transfusion ≥5 units, reoperation, or intentional delayed closure. The incidence of mediastinitis (2.0% vs. 0%), ventilator ≥24 hours (4.0% vs. 2.8%), atrial fibrillation (18.0% vs. 25.0%), mean intensive care unit stay (34.5 hours vs. 38.8 hours), and median hospital stay (8 days vs. 7 days) did not differ, either. CONCLUSION: AVR combined with additional aortic or root replacement showed an excellent outcome and recovery course equivalent to that after isolated AVR.