Composite graft replacement for the treatment of aneurysms of the ascending aorta associated with aortic valvular disease.

Composite graft replacement of the ascending aorta and aortic valve was performed in 78 patients over an 8 1/2-year period. Degenerative lesions of the aortic root in Marfan's syndrome (annuloaortic ectasia) was the indication for operation in 56 cases; the other 22 patients had other causes of aortic root dilatation and aortic valve disease. Overall hospital mortality was 8%. Follow-up ranged from 1-9 years (average 5 years). Reoperation was required in six of the 72 hospital survivors. Overall 5-year actuarial survival was 77%, and 85% of the survivors have shown significant clinical and radiologic improvement. Composite graft replacement reduces the risk of aneurysm formation of the sinuses of Valsalva and eliminates paraprosthetic leakage; postoperative hemorrhage is also reduced. It appears to be the method of choice for patients with degenerative lesions in the ascending aorta and valve, particularly annuloaortic ectasia.