Aortic valve repair and root preservation by remodeling, reimplantation, and tailoring: technical aspects and early outcome.
OBJECTIVE
Evaluate aortic root preserving/sparing procedures for various pathologies associated with ascending aortic aneurysms, including aortic valve regurgitation.


METHODS
From the end of 1990 through end of 2004, 388 patients had aortic root preserving procedures (reimplantation 72, remodeling 77, tailoring 239) +/- leaflet repair. Preoperatively, in-house grade aortic regurgitation was 1(+) in 58, 2(+) in 110, 3(+) in 101, and 4(+) in 66. Concurrent leaflet repairs were done in 197 (50.8%, Cabrol/Trusler commissure stitch 158, leaflet plication 36, supracommissure stitch 42, leaflet resection and repair 16, perforation repair 18, and debridement 11). Additional procedures included arch repair in 227 (58%), coronary bypass in 83 (21.4%), elephant trunk in 33 (8.5%), and minimally invasive approach in 30 (7.7%). Pathologies included dissection in 140 (36%; 86 acute), Marfan syndrome in 39 (10%), bicuspid valve in 78 (20%), and degenerative aneurysm in 142 (36.6%). The CLASS (Commissure, Leaflet, Annulus, Sinuses, Sinotubular) evaluation schema is described that is used for selecting either reimplantation, remodeling, or tailoring of the aortic root according to underlying pathology.


RESULTS
Hospital survival was 97.4% (378/388) and stroke occurred in 4.6% (18/388, four permanent, [1%]). On postoperative echocardiography, patients had either no (0) or 1(+) regurgitation (1(+)= 98);13 (3.4%) had 2(+). Three patients (1%) required reoperation for aortic valve failure before discharge (two tailoring, one remodeling).


CONCLUSIONS
Excellent early results can be achieved by aortic root preserving procedures and concurrent aortic valve leaflet repairs when appropriately selected for a diverse class of pathologies.
Center for Aortic Surgery, Marfan Syndrome and Connective Tissue Disorders Clinic, Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation Cleveland, Ohio 44195, USA. svenssl@ccf.org
Lars G
LG
Svensson
Indu
I
Deglurkar
Jin
J
Ung
Gosta
G
Pettersson
A Marc
AM
Gillinov
Richard S
RS
D'Agostino
Bruce W
BW
Lytle
D000465:Algorithms; D001011:Aorta / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D013504:Cardiovascular Surgical Procedures / Q000379:methods; D005260:Female; D006305:Health Status Indicators; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome