Perioperative Details
Intraoperative variables are shown in Table 2 . All 54 patients
underwent replacement of the aortic root with coronary reimplantation
using cryopreserved homograft. Forty-two patients (77.8%) had
concomitant surgical procedures including aorto-mitral curtain
reconstruction in 20 (37.0%), mitral valve repair in 13 (24.1%),
bioprosthetic mitral valve replacement in 10 (18.5%), tricuspid valve
repair in 9 (16.7%), and hemi aortic arch replacement under circulatory
arrest in 6 (11.1%). Ten patients (18.5%) had radical debridement and
patch repair or primary closure of aorto-atrial fistulae and/or acquired
atrial or ventricular septal defects due to extensive abscess formation
with tissue destruction. Of these, three had aorto-atrial fistulae, five
had atrial septal defects, and two had ventricular septal defects.
Nineteen patients (35.2%) with reoperative surgery required Cabrol
patch with Cooley fistula due to excessive aortic root hemorrhage.
Senior attending cases tended to have more aorto-mitral curtain
reconstruction (25.0% vs 50.0%, P=0.057) and also required Cabrol
patch (17.9% vs 53.9%, P=0.006). The median cross clamp time was
comparable (213 vs 227 minutes, P=0.08), but the median cardiopulmonary
bypass time was longer in the senior attending cases (280 vs 342
minutes, P=0.05).