Aortic aneurysm with aortic insufficiency, pathomorphology and surgical tactics

Between December 1978 and December 1998 91 patients were operated because of aneurysm of the ascending aorta associated with aortic regurgitation. Bentall procedure and its modifications were used in 82, allograft aortic root replacement - in 3, plastics of the aorta and aortic valve - in 3, aortic valve replacement by prosthesis combined with reconstruction of ascending aorta - in 3 patients. Intraoperative histological study of samples of aortic tissue and aortic valve cusps was routinely performed. Fragmentation of elastic fibers in the aortic media was found practically in all patients, then followed cystic changes of the media (78,1%), medial necrosis (14,3%), and thinning of vasa vasorum (10,9%). Total inhospital mortality was 12,1% (11 patients). Actuarial 5-year survival of 80 patients was 83,8%. The Bentall procedure should be preferred in aneurysm of the ascending aorta with concomitant aortic insufficiency of degenerative origin while plastic correction is advisable in predominant atherosclerosis and incipient degenerative changes of the aortic wall. Intraoperative histological study of tissue samples from the aortic wall can help to determine surgical tactics.