[Simultaneous replacement of the aortic valve and the ascending aorta: its operative procedure, early and late postoperative results: especially for annuloaortic ectasia and dissecting aneurysm of the aorta].

During the past 18 years, from March 1972 to February 1991, 105 patients had replacement of the ascending aorta and aortic valve. Operative techniques used in these patients, early and late postoperative results of these patients were reported. One hundred patients had composite graft replacement, and 76 patients of them were treated by Bentall's technique or its modification. Anastomotic leakages after Bentall's operation were found mostly at the bilateral coronary ostia, and incidence rate of the leakages experienced in the first 22 patients who had one lane coronary-graft anastomosis, reduced statistically significantly in patients who had two lane coronary-graft anastomosis, and also survival rate of these latter patients improved significantly than the former patients. A small caliber graft which was interposed between the coronary ostia and side holes of the composite graft was used for coronary reimplantation (Piehler's technique) in cases in which coronary ostia were not displaced cephalad, or in which dissection involved around the coronary ostial tissue even in annuloaortic ectasia. Also CABG was employed in a small number of patients. In the early postoperative results, overall operative mortality was 9.5%. In the long-term results for patients received composite graft replacement until 1989, the actuarial survival rate at 5, 10 and 14 years after surgery was 77, 66 and 60%, respectively. The actuarial survival rate for patients received composite graft replacement with two lane coronary anastomosis at 5 and 10 years after surgery was 82 and 76.2%, respectively, and this results were almost similar to the survival rate after AVR.