The sinotubular junction does not progressively dilate four years after modified subcoronary freestyle stentless tissue aortic valve replacement.
OBJECTIVE
Aortic root dilation at the sinotubular junction (STJ) results in aortic regurgitation associated with normal valves and with a complete subcoronary stentless aortic bioprosthesis. The study aim was to assess for progressive aortic root dilation following modified subcoronary Freestyle aortic valve replacement (AVR), and to compare for differences between implant techniques.


METHODS
Aortic root diameter was measured at the annulus, sinuses of Valsalva, STJ and tubular aorta on post-pump transesophageal echocardiograms and on early (3-month) and late (>2 years) transthoracic echocardiograms among 16 patients after modified subcoronary Freestyle valve replacement, 16 after root inclusion, and three after total root replacement.


RESULTS
Mean follow up was 3.9 +/- 0.8, 3.3 +/- 0.7 and 3.5 +/- 1.1 years for modified subcoronary, root inclusion and total root patients, respectively. The aortic annulus, sinuses and STJ increased in diameter to similar extents between surgery and three months after modified subcoronary and root inclusion surgery, with no further increase at late follow up (modified subcoronary STJ 18.4 +/- 3.7, 21.1 +/- 3.7 and 20.5 +/- 4.4 mm on intraoperative, early and late echocardiography, respectively; root inclusion STJ 21.8 +/- 3.9, 25.4 +/- 4.6 and 24.4 +/- 4.4 mm, respectively). There were no changes in aortic root diameter after total root replacement (STJ 23.7 +/- 1.2 and 25.7 +/- 6.0 on intraoperative and late follow up, respectively). Aortic regurgitation prevalence was low, and similar between groups.


CONCLUSIONS
Small but significant increases in aortic root dimensions were seen during the first three months after modified subcoronary and root inclusion surgery, with no subsequent change. The early changes were likely caused by resorption of paravalvular edema and hematoma transiently affecting aortic root measurements in the perioperative period. There was no evidence of progressive STJ dilation at 3.9 years after modified subcoronary Freestyle AVR.
Martin
Julie W
JW
Department of Medicine, Division of Cardiology, University of Michigan, Ann Arbor, Michigan, USA.
Deeb
G Michael
GM
Bach
David S
DS
D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D001705:Bioprosthesis; D001783:Blood Flow Velocity; D020099:Coated Materials, Biocompatible; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006334:Heart Function Tests; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology
D020099:Coated Materials, Biocompatible