Total composite graft replacement of the ascending aorta and aortic valve.

Ten patients (nine male and one female), ranging in age from 21 to 68 years, were operated on for total composite replacement of the ascending aorta and the aortic valve. Among them annulo-aortic ectasia was the most common indication (five patients), followed by annulo-aortic ectasia with aortic dissection (three patients), the aneurysm and aortic valve regurgitation associated with aortitis syndrome (one patient), and the syphilitic aneurysm and aortic valve regurgitation (one patient). In the first four patients, composite replacement was conducted according to the original procedure described by Bentall and DeBono (1986). The next six patients were treated according to the procedure modified by Cabrol et al. (1981). There were no operative deaths or complications during hospitalization. However, late complications occurred in two patients at 46 months and 15 months after surgery, respectively. Despite the repair on an urgent basis, one died of hepatic failure and the other died on the table with massive disruption. Eight late survivors remain in the New York Heart Association (NYHA) class 1 on an average of 4.3 years postoperatively. It is concluded that total replacement with a composite graft is feasible in all patients with low operative mortality, but this procedure needs a close follow-up because of the potential for anastomotic dehiscences.