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The Annals of Thoracic Surgery, Vol 40, 439-455, Copyright © 1985 by The Society of Thoracic Surgeons
ES Crawford, JL Crawford, HJ Safi and JS Coselli
Sixty-seven operations were performed in 59 patients for aneurysmal disease
occurring after previous operations involving the ascending aorta and
transverse aortic arch. The initial aortic pathological condition included
the following: fusiform aneurysm due to medial degenerative disease in 34
patients, 12 of whom had Marfan's syndrome; aortic dissection in a
previously undilated aorta in 23; and aneurysm persisting or occurring
after brachiocephalic bypass in 2. One of the latter had an aneurysm
because of aortitis. Various operations initially performed did not
completely treat the disease, and certain complications occurred
spontaneously, including infection and dissection. The residual
pathological condition led to the development of aortic insufficiency,
aortic dissection, coronary artery insufficiency, and progressive
aneurysmal dilatation. These complications were treated by composite valve
graft replacement of the aortic valve and ascending aorta or the transverse
aortic arch or both, simple aortic valve replacement, graft replacement of
the ascending aorta or arch or both, and suture of false aneurysm with
viable tissue wrap. Twenty patients (34%) had an aneurysm of the distal
aorta. The entire aorta was replaced in 3, thoracoabdominal segments in 9,
and the abdominal aorta in 1. Of the 59 patients, 49 (83%) were early
survivors and 40 (68%) were alive on January 1, 1985. Principles of therapy
that may have prevented the complications leading to reoperation include
aneurysm replacement at the time of aortic valve replacement and coronary
artery bypass; total replacement of the ascending aorta and aortic valve in
patients with Marfan's syndrome; the same procedure or aortic valve
replacement and separate graft replacement in patients with non-Marfan's
medial degenerative disease; ascending aortic replacement in all patients
with dissection combined with valve resuspension, aortic valve replacement,
or composite valve graft depending on the involvement of the aortic sinuses
and the presence of aortic insufficiency.
ARTICLES
Redo operations for recurrent aneurysmal disease of the ascending aorta and transverse aortic arch
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