Valve-sparing aortic root replacement: early experience with the De Paulis Valsalva graft in 51 patients.
BACKGROUND
Valve-sparing aortic root replacement for treatment of aortic sinus disease avoids the problems of prosthetic valves, but some patients suffer late valve incompetence as a result of leaflet distortion or annular dilatation. The reimplantation technique using the De Paulis Valsalva graft might improve late results of valve-sparing aortic root replacement by maintaining annular stability and re-creating sinuses that minimize leaflet stress.


METHODS
Retrospective review was conducted of all patients at our institution who underwent valve-sparing aortic root replacement using the Valsalva graft. Clinical data were obtained from hospital and clinic charts and patient contacts; echocardiograms were analyzed for aortic root dimensions and valve function.


RESULTS
Between May 2002 and June 2005, 51 patients underwent valve-sparing aortic root replacement using the reimplantation technique with the Valsalva graft. Mean age was 33 +/- 15 years; 22% (11 of 51) were children, and 80% (41 of 51) were male. Primary indication for surgery was root aneurysm in all patients. Preoperative mean root diameter was 5.0 +/- 0.5 cm. Marfan syndrome was present in 67% (34 of 51), and 10% (5 of 51) had the newly described Loeys-Dietz syndrome. There were no operative or late deaths, and no patient required reoperation for bleeding. At mean follow-up of 1.8 years, there were no episodes of endocarditis or thromboembolism. Echocardiograms showed stability of the annulus and root dimensions on follow-up. No patient had more than 0 to 1+ aortic insufficiency or progression of aortic insufficiency. All were in New York Heart Association class I.


CONCLUSIONS
Valve-sparing aortic root replacement using the Valsalva graft and reimplantation technique has excellent early results. Preservation of valve competence is encouraging, but long-term results will determine whether the anatomic design of this aortic root prosthesis is superior for preservation of valve integrity.
Patel
Nishant D
ND
Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Williams
Jason A
JA
Barreiro
Christopher J
CJ
Bethea
Brian T
BT
Fitton
Torin P
TP
Dietz
Harry C
HC
Lima
Joao A C
JA
Spevak
Philip J
PJ
Gott
Vincent L
VL
Vricella
Luca A
LA
Cameron
Duke E
DE
D000293:Adolescent; D000328:Adult; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002648:Child; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012850:Sinus of Valsalva / Q000601:surgery*; D014463:Ultrasonography