Early results of valve-sparing reimplantation procedure using the Valsalva conduit: a multicenter study.
BACKGROUND
This study evaluates the midterm clinical results of valve-preserving aortic root reconstruction by means of a modified conduit incorporating sinuses of Valsalva.


METHODS
During a 5-year period, 151 patients with aneurysm of the aortic root underwent a reimplantation type of valve-sparing procedure using the Gelweave Valsalva prosthesis that incorporates sinuses of Valsalva. There were 121 males (80.1%), and the mean age was 56.4 +/- 14.4 years (range, 14 to 83). Fourteen percent of the patients had Marfan syndrome and 8.6% had bicuspid aortic valve. Seven patients (4.6%) suffered from acute aortic dissection. Aortic replacement was extended to the arch in 14 patients (9.3%). Sixteen patients (10.6%) had associated cusp repair.


RESULTS
In-hospital mortality was 3.3%, and it was significantly higher among patients operated on for acute dissection (p = 0.001) and in symptomatic patients (III-IV New York Heart Association class; p = 0.021). Follow-up (mean, 18 months; range, 1 to 60) was 100% complete. There were 2 late deaths. Ten patients (6.8%) had 3 to 4+ aortic regurgitation, and 8 of these required late aortic valve replacement. Cusp repair was associated with a high incidence of late aortic valve replacement (p = 0.005). At 5 years, freedom from aortic valve replacement and freedom from grade 3 to 4 aortic insufficiency was 90.8% +/- 3.3% and 88.7% +/- 3.6%, respectively.


CONCLUSIONS
The reimplantation valve-sparing procedure with the Gelweave Valsalva prosthesis provides satisfactory results for patients with aortic root aneurysm. Aortic cusp repair may lead to late aortic insufficiency. Proper leaflet evaluation is of paramount importance in preventing residual valve regurgitation.
Pacini
Davide
D
Cardiac Surgery Department, S. Orsola-Malpighi Hospital, University of Bologna, Bologna. dpacini@hotmail.com
Settepani
Fabrizio
F
De Paulis
Ruggero
R
Loforte
Antonino
A
Nardella
Saverio
S
Ornaghi
Diego
D
Gallotti
Roberto
R
Chiariello
Luigi
L
Di Bartolomeo
Roberto
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000209:etiology / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000453:epidemiology; D002303:Cardiac Output, Low / Q000209:etiology / Q000401:mortality; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007422:Intestines / Q000098:blood supply; D007511:Ischemia / Q000209:etiology / Q000401:mortality; D008297:Male; D008382:Marfan Syndrome / Q000150:complications / Q000601:surgery; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D011475:Prosthesis Failure; D012092:Replantation / Q000379:methods / Q000706:statistics & numerical data; D012850:Sinus of Valsalva / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome