Aortic root replacement in young adults: disease characteristics and early outcome

Abstract

Introduction

Aortic pathology requiring replacement of the aortic root is rare in young adults and maybe a group prone to atypical presentation and poorer outcomes. Here, we have studied the clinical features, pathological extent of aortic root disease and outcome of young adults undergoing aortic root replacement at this institution between 1995 and 2005.

Patients and methods

Retrospective study of the patients who underwent aortic root replacement at this institution between 1995 and 2005 between the ages of 18 and 40 (n = 53). Preoperative, intra-operative and postoperative data were collected on a standardized proforma.

Results

There were 48 males (90.5%) and five females (9.5%). Mean age was 32.3 ± 0.7 years. 44% of patients had a preoperative diagnosis of either bicuspid or rheumatic aortic valve disease; 46 (87%) presented with chest pain and in 34 patients (64%) an aortic regurgitant murmur was audible. Most patients had aorto-annular ectasia, with 17 (32%) with aortic dissection. The dissecting flap arose at or near the sinotubular junction in 88% and terminated in the ascending aorta in 60%. 45 patients (84.9%) received modified Bentall’s procedure; the rest underwent separate aortic valve and supra coronary aortic replacement. In hospital mortality was 1.8%. Follow up was 96% at mean follow up of 8.56 years after surgery.

Conclusion

Aortic surgery may be performed in young adults with good results. The disease characteristics of aortic dissection in this age group are favorable. The use of the Bentall procedure or separate aortic valve and supra coronary ascending aortic replacement offers good early and late clinical outcomes.