Surgical treatment of annuloaortic ectasia.

Twenty-two patients with annuloaortic ectasia (an aneurysm of the ascending aorta and aortic valve incompetence) due to cystic medionecrosis underwent surgical repair between 1967 and 1979. Twelve patients had Marfan's syndrome and 4 had a forme fruste. The use of a valved conduit and improved techniques of myocardial protection have reduced the perioperative risks and may improve the survival of these patients. Between July 1, 1967 and June 30, 1978, 12 patients had supracoronary repair of the aneurysm and replacement of the aortic valve (group 1); the mortality was 17% (2 of 12). Between July 1, 1978 and Aug. 31, 1979, 10 patients underwent insertion of a valved conduit with implantation of the coronary arteries (modified Bentall procedure, group 2); the operative mortality was 10%. In five group 1 patients (42%) and two group 2 patients (20%) technical problems resulted in bleeding in the early postoperative period. Evidence of a recurrent aneurysm in the diseased segment of the proximal aorta developed in 2 of the 10 group 1 survivors, at 2 and 4 years after operation, respectively. Use of the modified Bentall procedure and cold potassium cardioplegia reduced operative complications from 58% (7 of 12 in group 1) to 20% (2 of 10 in group 2). Because of the low risk of the current procedure and the high risk associated with its natural history, operative intervention should be considered for asymptomatic patients with annuloaortic ectasia.