Adult: Aorta
Long-term experience with valve-sparing reimplantation technique for the treatment of aortic aneurysm and aortic regurgitation

Read at the 98th Annual Meeting of The American Association for Thoracic Surgery, San Diego, California, April 28-May 1, 2018.
https://doi.org/10.1016/j.jtcvs.2018.10.155Get rights and content
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Abstract

Objective

To analyze our long-term experience with valve-sparing reimplantation technique for the treatment of isolated root aneurysm, aneurysm with significant aortic regurgitation, and for isolated aortic regurgitation.

Methods

Between 1999 and 2017, 440 consecutive patients underwent valve-sparing reimplantation in our institution. The mean age of this cohort was 49 ± 15 years. Time-to-event analysis was performed with the Kaplan-Meier method, whereas significant predictors of late outcomes were explored with Cox proportional hazard model.

Results

In-hospital mortality was 0.7% (n = 3). Four hundred fourteen patients were available for long-term analysis. Median duration of follow-up was 5 years (interquartile range, 2-8.5 years). Thirty-six patients (8.5%) died during follow-up; therefore, survival was 79.7% ± 3.8% at 10 years. During follow-up we observed a linearized rate of 0.37%, 0.73%, and 0.2% patient-year, respectively, for major bleeding, thromboembolic events, and infective endocarditis. Nineteen patients required late aortic valve reoperation and freedom from valve reoperation was 89.6% ± 2.9% at 10 years and was not significantly different between groups or between tricuspid or bicuspid valve phenotypes.

Conclusions

Our study shows that valve-sparing reimplantation is associated with low perioperative mortality, a remarkably low rate of valve-related complications, and excellent long-term durability. Further, it can be safely performed also in patients with isolated aortic regurgitation and the durability of valve repair is similar regardless of the indication for surgery of valve phenotype.

Key Words

aortic valve sparing
reimplantation

Abbreviations and Acronyms

AR
aortic regurgitation
AV
aortic valve
BAV
bicuspid aortic valve
LVEDD
left ventricle end diastolic volume
NYHA
New York Heart Association
STJ
sinotubular junction
TAAD
type A acute aortic dissection
VAJ
ventriculoaortic junction
VSR
valve sparing root replacement with the reimplantation technique

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