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ORIGINAL ARTICLE

Ten years of operation for aneurysms or chronic dissections of ascending aorta, in the Instituto do Coração - FMUSP

Ronaldo Ducceschi Fontes; Noedir A. G Stolf; Domingos D Lourenço Filho; Ricardo Tranchesi; Charles Mady; Antônio Carlos Pereira-Barreto; Fúlvio Pileggi; Adib D Jatene

DOI: 10.1590/S0102-76381991000100005

ABSTRACT

From January 1980 to Dezember 1990, 109 patients, 86 males and 16 females, ranging in age from 12 to 70 years, were operatated on for aneurysms or chronic dissections of the ascending aorta, associated or not to aortic valve insufficiency. Thirty-four patients were in New York Heart Association class IV, 51 in class III, 18 in class II and six in class I. Fifty-two patients had chronic aortic dissection, 29 annulo-aortic ectasia, 10 saaular aneurysm, remaining 8 ethiologics. The early mortality was 12.8% (14 deaths). Twenthy-seven patients were lost for follow-up during a period ranging from three months to 10 years (average 82 months). The late mortality was 13.4% (11/82). Among the 72 patients survivors, clinicai improvement was observed in the majority of patients (90.5% are in class I or II). Among the several operative techniques, the Bentatt and De Bono showed better early survival and is preferable option when indicated. The actuarial curve showed a 70% survival for the whole group, after 120 months. The results observed in terms of survival and clinical improvement suggest that surgery is the treatment of choice for aneurysms and chronic dissections of ascending aorta.

RESUMO

Entre janeiro de 1980 e dezembro de 1990, 109 pacientes com idade entre 12 e 70 anos, 86 do sexo masculino e 23 do sexo feminino, foram operados para tratamento de aneurismas e dissecções da aorta ascendente, associados ou não a insuficiência aórtica. Trinta e quatro pacientes estavam em classe funcional (CF) IV (NYHA), 51 em CF III, 18 em CF II e seis em CF I. Cinqüenta e dois pacientes tinham dissecção crônica da aorta, 29 tinham ectasia ânulo-aórtica, dez aneurisma sacular com insuficiência aórtica e os demais, diagnósticos associados. A mortalidade imediata foi de 12,8% (14 óbitos). Vinte e sete (24,7%) pacientes não foram acompanhados tardiamente. A mortalidade tardia foi de 13,4% (11/82). Dos 72 pacientes acompanhados clinicamente até 120 meses de evolução (três a 120 meses), 65 (90,5%) mantêm-se em CF I e II. Concluiu-se que: a operação de Bentall - De Bono, demonstra ter melhor resultado em relação às interposições de tubo (p < 0,01), com estimativa de função de sobrevida de 70% em 120 meses, com excelente evolução clínica tardia.
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REFERENCES

1. ACAR, J.; GUIMARD, A.; BANDOUY, P. A. - Les insuffisances aotiques par aneurysme dystrophique de l'aorte ascendante. Arch. Mal. Coeur., 72: 596-605,1979.

2. ASANO, K.; ANDO, T.; HANADA, S.; MARUYAMA, Y. - Control of bleeding during the Bentall operation. J. Cardiovasc. Surg., 24: 13-14, 1983.

3. BACHET, J.; GIGOU, F.; LAURIAN, E.; BICAL, O.; GOUDOT, B.; DUBOIS, C.; BRODARY, D.; GUILMET, D. - Quatre ans d'expérience clinique de la colle gelatine - resorcine - formol dans les dissections aigües de l'aorta ascendante. Arch. Mal. Coeur., 76: 87-94, 1983.

4. BENTALL, M. & De BONO, A. - A techinique for complete replacement of ascending aorta. Thorax, 23: 388-390, 1980.

5. CABROL, C. - Annuloplastie valvulaire: un nouveau procédé. Presse Med., 1: 366-369, 1972.

6. CABROL, C.; GRANDHBAKHCH, I.; CHAM, B. - Aneurysmes de l'aorte ascendante: replacement total avec reimplantation des arteries coronaines. Presse Med., 7: 363-365, 1978.

7. CABROL, C.; GANDJBAKHCH, I.; PAVIE, A. - Surgical treatment of ascending aortic pathology. J. Cardiac. Surg., 3: 167-180, 1988.

8. CABROL, C.; PAVIE, A.; GRANBJDAKHCH, I. - Complete replacement of ascending aorta with reimplantation of the coronary arteries: new surgical approach. J. Thorac. Cardiovasc. Surg., 81: 309-315, 1981. [MedLine]

9. CRAWFORD, E. S. - Aortic dissection. Ann. Surg., 208: 251-273, 1988.

10. CRAWFORD, E. S. - Progress in the treatment of thoracic aortic aneurysms. World J. Surg., 12: 805-809, 1988. [MedLine]

11. EDWARDS, W. S. & KERR, A. A. - A safer technique for replacement of the entire ascending aorta and aortic valve. J. Thorac. Cardiovasc. Surg., 59: 837-839, 1970. [MedLine]

12. EGLOFF, L.; ROTHLIN, M.; KUGELMEIER, J.; SENNING, A.; TURINA, M. - The ascending aortic aneurysm: replace o repair? Ann. Thorac Surg., 34: 117-124, 1982. [MedLine]

13. HASHIMOTO, A.; SHIMAZU, K.; NAKAMURA, K. - Later complication after composite replacement of anulo aortic ectasia. J. Cardiovasc. Surg., 24: 277-279, 1983.

14. HELSETH, H. K.; HAGLIN, J. J.; MANSON, B. K.; WICKSTRON, P. - Results of composite graft, replacement of aortic root aneurysms. J. Thorac. Cardiovasc. Surg., 80: 754-759, 1980. [MedLine]

15. MAYER, J. E.; LINDSAY, W. G.; WANG, Y.; JORGENSEN, C. R.; NICOLOFF, D. M. - Composite replacement of the aortic valve and ascending aorta. J. Thorac. Cardiovasc. Surg., 79: 816-824, 1978.

16. MILLER, D. C.; STINSON, E. B.; AFER, P. E.; MORENO-CABRAL, R. I.; REITZ, B. A.; ROSSITER, S. J.; SHUMWAY, N. E. - Concomitant resection of the aortic valve: operative and long-term results with "conventional" techniques in ninety patients. J. Thorac. Cardiovasc. Surg., 79: 388-401, 1980. [MedLine]

17. ORSZULAK, T. A.; CLEMENTS, I. P.; TINKER, J. H. - Björk-Shiley leaflet impairment in an ascending aortic conduit due to extrinsic compression by a false aneurysm. Ann. Thorac. Surg., 34: 706-709, 1982. [MedLine]

18. SIEGEL, S. - Estatística não paramétrica. São Paulo, Mc Graw-Hill, 1981, 350 p.

19. THEVENET, A. & MARY, H. - Problèmes chirurgicaux particuliers des dissections du syndrome de Marfan. Le remplacement de l'aorte ascendante et de la valve aortique avec reimplantation de coronaires: a propos de 3 cas. Ann. Chir. Thorac. Cardiovasc., 33: 632-636, 1979.

20. WHEAT Jr., M. N.; WILSON, J. R.; BARTLEY, T. D. - Successful replacement of the entire ascending aorta and aortic valve. JAMA, 188: 717-719, 1964. [MedLine]

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