Residual aortic valve regurgitation after aortic root remodeling without a direct annuloplasty.
BACKGROUND
Aortic insufficiency secondary to degenerative aneurysms of the ascending aorta can be surgically treated with replacement of the valve or with remodeling of the aortic root.


METHODS
In 15 patients who underwent aortic root remodeling from January 1994 to December 1996, we evaluated the postoperative aortic regurgitation and correlated it with several anatomic and functional variables. Operative success was defined as a residual aortic regurgitation less than or equal to 1 on a scale of 0 to 4.


RESULTS
Root dimensions and aortic incompetence decreased significantly after the operation (p < 0.0001). The difference between preoperative and postoperative root diameters (p = 0.0006) and the presence of Marfan's syndrome (p < 0.0001) were independently predictive of persisting significant aortic insufficiency. Operative success was obtained in patients with a difference between preoperative and postoperative root diameters smaller than 30 mm.


CONCLUSIONS
Aortic root remodeling is effective in reducing aortic regurgitation. Severe aortic root dilatation may result in excessive geometric alteration, leading to suboptimal results. The choice of a larger graft contributes to avoiding excessive geometric constraint of a profoundly diseased aortic root. Indication to undergo root remodeling should be evaluated cautiously in patients with Marfan's syndrome.
Bassano
C
C
Department of Cardiac Surgery, Tor Vergata University, European Hospital, Rome, Italy.
De Paulis
R
R
Penta de Peppo
A
A
Tondo
A
A
Fratticci
L
L
De Matteis
G M
GM
Ricci
A
A
Sommariva
L
L
Chiariello
L
L
D001014:Aortic Aneurysm / Q000601:surgery*; D001021:Aortic Valve; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000150:complications; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D012044:Regression Analysis; D016896:Treatment Outcome