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.