Aortic valve preservation in patients with aortic root aneurysm: results of the reimplantation technique.
BACKGROUND
A study was conducted to determine the long-term results of aortic valve reimplantation to treat aortic root aneurysm.


METHODS
Prospective follow-up with clinical assessments and echocardiography was done of 167 consecutive patients who had reimplantation of the aortic valve as treatment of aortic root aneurysm. Their mean age was 45 +/- 15 years, 78% were men, 38% had Marfan syndrome, 14% had aortic dissection, and 7% had bicuspid aortic valve. The aortic valve was reimplanted into a straight Dacron (Dupont, Wilmington, DE) tube in 89 patients and in a Dacron tube with creation of neoaortic sinuses in 78. Aortic cusp repair was performed in 66 patients, and the free margin was reinforced with a fine Gore-Tex suture (W.L. Gore & Assoc, Flagstaff, AZ) in 36. The mean follow-up was 5.1 +/- 3.8 years and was 100% complete.


RESULTS
There were two operative and six late deaths. Survival at 10 years was 92% +/- 3%. Moderate aortic insufficiency developed in 3 patients, and severe developed in 2. Freedom from moderate or severe aortic insufficiency was 94% +/- 4% at 10 years. Two patients required aortic valve replacement. Freedom from aortic valve replacement was 95% +/- 4% at 10 years. At the latest follow-up, 90% of the patients were in New York Heart Association functional class I and 10% were in class II.


CONCLUSIONS
Reimplantation of the aortic valve to treat patients with aortic root aneurysm is associated with excellent long-term survival and low rates of valve-related complications. Reimplantation of the aortic valve is a durable type of aortic valve repair.
David
Tirone E
TE
Division of Cardiovascular Surgery, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada. tirone.david@uhn.on.ca
Feindel
Christopher M
CM
Webb
Gary D
GD
Colman
Jack M
JM
Armstrong
Susan
S
Maganti
Manjula
M
D000328:Adult; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000503:physiopathology; D001807:Blood Vessel Prosthesis; D016757:Death, Sudden, Cardiac / Q000209:etiology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000150:complications; D008875:Middle Aged; D011446:Prospective Studies; D012092:Replantation / Q000379:methods / Q000401:mortality; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome