Aortic valve reimplantation in ascending aortic aneurysm: risk factors for early valve failure.
BACKGROUND
Aortic root reconstruction by reimplantation of the native valve represents a new therapeutic option for ascending aortic aneurysms. Information about long-term follow-up is limited, and possible predictors for failure of reconstruction have not been evaluated so far.


METHODS
After aortic valve reimplantation 101 patients were followed in a prospective observational study. From this cohort the first 75 consecutive patients with a complete 1-year follow-up were chosen for further analysis. Clinical and echocardiographic data were obtained preoperatively, intraoperatively, and early postoperatively, as well as after 1 year of follow-up.


RESULTS
No mortality was observed within the first 30 days. There were 52 male patients, mean age was 49.1+/-20.6 years, observation period was 35.6+/-20.6 months, and Marfan's syndrome was present in 22 patients. Although in 67 patients a stable valve function could be demonstrated, 5 patients presented with mild aortic insufficiency or had to be operated on again for secondary valve failure (n = 3). Analyzing possible demographic, disease-related, and procedure-related risk factors in a multivariable approach, only level of coaptation within the graft (as assessed by echocardiography) could be identified as being related to the subsequent development of aortic insufficiency. Coaptation level within the tube graft (type A) resulted in a mean aortic regurgitation grade of 0.3+/-0.5 as compared with a mean grade of 2.5+/-0.6 for a coaptation type C (below the prosthesis; p < 0.001).


CONCLUSIONS
Aortic valve reimplantation is a promising alternative to alloprosthetic composite replacement. A level of coaptation within the tube graft is essential to achieve valve competence.
Pethig
Klaus
K
Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Germany. klaus.pethig@t-online.de
Milz
Andrea
A
Hagl
Christian
C
Harringer
Wolfgang
W
Haverich
Axel
A
D000293:Adolescent; D000328:Adult; D000368:Aged; D001014:Aortic Aneurysm / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012092:Replantation; D012307:Risk Factors; D017211:Treatment Failure; D016896:Treatment Outcome