CVM Cardiovascular Medicine 1664-204X 1664-2031 EMH Schweizerischer Ärzteverlag AG Farnsburgerstrasse 8 CH-4132 Muttenz 02172 10.4414/cvm.2021.02172 Original article Valvular heart disease Composite graft replacement of the aortic root: experience in a tertiary care teaching institution Meyer Judith Departement of Cardiovascular Surgery, University Hospital Bern Schoenhoff Florian Departement of Cardiovascular Surgery, University Hospital Bern Carrel Thierry-Pierre thierry.carrel@gmail.com SWITZERLAND | +41442552111 01 07 2021 24 04 0 0 Copyright: EMH Schweizerischer Ärzteverlag AG 2021 EMH Schweizerischer Ärzteverlag AG "Cardiovascular Medicine" is an open access publication of EMH published in accordance with the terms of the Creative Commons licence attribution - NonCommercial - NoDerivatives 4.0 International. You are free to share, copy and redistribute the material in any medium or format under the following terms: Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. NonCommercial — You may not use the material for commercial purposes. NoDerivatives — If you remix, transform, or build upon the material, you may not distribute the modified material. "Non-commercial" means not primarily intended for or directed towards commercial advantage or monetary compensation. The incorporation of publications in commercial products, the use of publications to advertise for commercial products or services and any other usage that directly or indirectly pursues commercial interests is subject to the express previous consent of the publishing house as part of a written agreement. Please send us your request in writing. Exact indication of the publication from which you would like to reproduce material and detailed information about its intended use help to facilitate and expedite request processing.

Composite graft replacement is an established surgical procedure that radically treats pathologies of the aortic root, especially when the aortic valve cannot be spared. We analyzed the intraoperative details and the short-term outcome of a large consecutive series of patients operated in a teaching tertiary institution. Out of 877 patients that received a composite graft during a 13-years period, we excluded all those patients who were operated as an emergency because of a type A acute aortic dissection, those who received this procedure as a redo-surgery and those who presented with a destructive endocarditis of the aortic root. Finally 622 patients with a mean age of was 59.5 ± 12.5 years (range between 16 and 85 years) were analyzed. 423 patients (68%) were male, mean body mass index was 27.8 ± 4.3 (18.4 to 37.3). Anulo-aortic dilatation with or without aortic valve dysfunction was the most frequent indication (n=448), bicuspid valve with aortic root and/or ascending aortic dilatation was found in 107 patients and typical aortic root dilatation in the presence of Marfan/Loeys-Dietz syndrome was found in 33 patients. A large majority of patients presented with moderate or severe aortic regurgitation (n=409, 65%), while aortic stenosis was present in 164 patients (26.5%). Early mortality occurred in 9 patients (1.4%). Causes of death were: low output syndrome in 3, severe cerebrovascular complication in 4 patients and respiratory, respectively multiorgan failure in one patient each. Multivariate logistic regression analysis showed that a severly reduced LV function (LV-EF < 0.35)  (OR 4.9, 95% CI 1.7-12.2), aortic regurgitation grade IV (OR 6.35, 95% CI 1.8-17.8), NYHA functional class III or IV (OR 2.94 (95% CI 1.5-7.4) and need for additional CABG surgery (OR 4,25, 95% CI 1.6-11.3) were the independent risk factors for mortality as well as for early morbidity.   Composite graft replacement is a standard procedure to treat different pathologies of the aortic root and is associated with a low perioperative risk. This justify liberal indications in case of moderately dilated aortic root (4.5 to 5 cm) in younger patients (<60 years) and in those with a particular cardiovascular risk profile.