Aortic root aneurysms: remodeling or composite replacement?
BACKGROUND
Patients with ascending aortic aneurysms often have aortic insufficiency due to dilatation of the aortic root. Although composite replacement of the aortic valve and ascending aorta has been the standard treatment, an aortic valve-sparing operation is feasible in patients with normal aortic valve leaflets.


METHODS
From 1988 to 1996, 208 patients with ascending aortic aneurysms and aortic insufficiency were operated on. Aortic valve-sparing operations were performed in 101 patients: 70 men and 31 women with a mean age of 53 years (range, 14 to 82 years). Twenty-eight patients had the stigmata of Marfan's syndrome. Fifteen patients had acute and 8 had chronic type A aortic dissection. Coronary artery disease was detected in 19 patients and mitral regurgitation in 5. Two types of aortic valve-sparing operations were performed: remodeling of the aortic root with preservation of the aortic valve in 73 patients and reimplantation of the aortic valve in a tubular Dacron graft in 28. Patients were followed up from 3 to 108 months (mean, 31 months). Doppler echocardiographic studies were performed annually.


RESULTS
There were two operative deaths. One patient had to have aortic valve replacement because of persistent aortic insufficiency. There were five late deaths; the actuarial survival rate at 6 years was 87% +/- 5%. One patient required aortic valve replacement 2 years after the initial operation; the freedom from aortic valve replacement at 6 years was 97% +/- 2%. There have been no thromboembolic or infective complications. Only 3 patients have moderate aortic insufficiency; the remaining patients have mild or no aortic insufficiency.


CONCLUSIONS
The midterm results of aortic valve-sparing operations have been excellent and justify their continued use in patients with aortic root aneurysms and normal or near-normal aortic valve leaflets.
David
T E
TE
Division of Cardiovascular Surgery, Toronto Hospital, University of Toronto, Ontario, Canada.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001014:Aortic Aneurysm / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods