Annulo-aortic ectasia extending to the arch: Composite graft repair with circulatory arrest

OBJECTIVE: To examine the results of surgery performed in patients with annulo-aortic ectasia extending to the arch. DESIGN: Retrospective hospital record review. SETTING: A Canadian teaching hospital. PATIENTS: Five patients (mean age 57 years) had annulo-aortic ectasia with severe aortic insufficiency, a maximum aneurysmal diameter ranging from 6.5 to 13 cm at the root or ascending aortic level, and extending into the arch with a diameter of at least 5 cm at the innominate artery level. They all had reconstruction with a composite prosthetic valve and Dacron tube graft employing standard techniques of aortic root replacement as well as aortic arch reconstruction with a single bevelled anastomosis in a state of profound hypothermia and circulatory arrest. MAIN RESULTS: No perioperative deaths, neurological complications nor significant cardiac complications. At a median follow-up period of 46 months all patients are alive, free from cardiovascular symptoms and show no evidence of aortic aneurysmal disease. CONCLUSIONS: This safe, effective and durable repair should be applied to selected patients with annulo-aortic ectasia which extends to the arch.