[Aortic valve sparing surgery].
BACKGROUND
Over the past 20 years, a series of procedures have been designed to reconstruct the aortic root of patients with aortic insufficiency, in whom the pathology and hence, the surgery, spares the valve leaflets. The objective of this current study was to evaluate our midterm results comparing the reimplantation technique with the remodeling technique in patients with aortic regurgitation due to aortic dissection, aortic root and ascending aortic aneurysms.


METHODS
During the years 1993 and 2006 we operated on 209 patients with aortic regurgitation secondary to dilatation of the aortic root or ascending aorta with or without aortic dissection. Mean age was 59 years (range 21-81 years), 69% of the patients were males; 91 patients had chronic aneurysm, while 118 patients presented with acute dissection. Thirty-nine patients had Marfan syndrome or it's form fruste. Post-operative follow-up (FU) was 82% complete (172 patients) with mean follow-up time of 66 months, and completion of FU was continued.


RESULTS
Thirty-nine patients underwent the reimplantation technique, 89 patients underwent the remodeling technique. Twenty-five patients underwent only replacement of the ascending aorta on the level of the STJ, 11 patients had replacement of the ascending aorta and one sinus. In 45 of the cases bio-glue was used in addition to replacing the ascending aorta. Overall, 30 days mortality was 5.7% (12 patients out of 209). There was no difference in mortality rates among the groups of patients who underwent reimplantation (chronic aneurysm vs Acute dissection), but significantly higher mortality rate was observed among patients who had aortic dissection and underwent the remodeling technique compared to the same group of patients who underwent reimplantation (6.7% vs 1.1%, P < 0.025). It was also found that Marfan patients who had aortic dissection had significantly higher mortality rate when undergoing the remodeling technique (7.6% Vs 0%, p < 0.01). Recurrence of AI more than 2+ occurred in 11 patients, ten from the remodeling and one from the reimplantation group (P = 0.17). Among Marfan patients, recurrence of AI more than 2+ occurred in two patients, both underwent remodeling and both had dissection of the ascending aorta involving the sinuses of Valsalva. Reoperation due to Severe AI was needed for 8 patients, all from the remodeling group and all were non-Marfans.


CONCLUSIONS
In acute dissection reimplantation provides better haemostasis and there may be more stable repair, both in Marfan and non-Marfan patients. In Marfans it seems that the reimplantation technique provides better long-term results.
Sheick-Yousif
Basheer
B
Department of Cardiothoracic Surgery, Sheba Medical Center, Tel Hashomer, affiliated to the Sackler Faculty of Medicine, Tel Aviv University. Basheers@zahav.net.il
Shinfeld
Amihay
A
Tager
Salis
S
Priesman
Sergey
S
Smolinsky
Aram K
AK
Raanani
Ehud
E
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery; D001014:Aortic Aneurysm / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000150:complications; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors