Echocardiographic follow-up
Of the surviving patients in the AAG group, 80% underwent follow-up
echocardiography. Only 2 patients had moderate or severe aortic
regurgitation (AR) on discharge from hospital. During the follow up
period, a further 9 patients developed moderate AR and 3 patients
developed severe AR. Figure 2 shows the degree of AR determined by
transthoracic echocardiography, incidence of reintervention and
mortality during the follow-up period. The degree of AR was assumed to
be constant until a follow-up transthoracic echocardiogram showed
deterioration in the function of the valve.
Table 6 shows the average growth rates of the aortic root in patients
undergoing AAG following ATAAD. 2 patients met the threshold for
reintervention on the aortic root based on the dimensions of the aortic
root [10]. In one case the patient underwent freestyle composite
valve-graft replacement of the root and valve due to an ascending aortic
aneurysm with the point of maximum dilation at the level of the Sinus of
Valsalva. The second patient underwent replacement of the supracoronary
graft due to development of a pseudoaneurysm at the proximal suture
line.
The degree of aortic regurgitation and the dimensions of the aortic root
at presentation and operative variables including CPB, cross clamp and
deep hypothermic circulatory arrest times did not predict reintervention
on the aortic root, development of severe aortic regurgitation or death
using the multivariate logistic regression analysis. Root replacement
and increased circulatory arrest time was associated with operative
mortality. Full statistical results are presented in appendix 1.