title: Reimplantation valve-sparing aortic root replacement for aortic root aneurysm in the elderly: are we pushing the limits?
abstract: OBJECTIVE
  Reimplantation valve-sparing aortic root replacement has been increasingly performed with improving perioperative and midterm results. However, extending the age criterion in patient selection remains a debate. This study reviews the results of reimplantation valve-sparing aortic replacement in patients greater than 60 years of age.
  
  
  METHODS
  During a 51-month period, 63 patients with aortic root aneurysms underwent reimplantation valve-sparing aortic root replacement. The Gelweave Valsalva prosthesis (TERUMO CardioVascular Systems Corp., Ann Arbor, MI, USA) was used in all but one case. The patients were predominantly male, and the mean age was 67 years (range, 61-83 years). Four patients had congenital bicuspid aortic valves, and cusp repair was required in one patient. The mean follow-up was 25 months (range, 1-51 months).
  
  
  RESULTS
  There were one hospital and two late deaths. Overall survival at 51 months was 84 +/- 9.9%. During follow-up, one patient developed severe aortic incompetence (AI) requiring an aortic valve replacement (AVR). Freedom from reoperation at 51 months was 92.8 +/- 6.8%. Moderate AI was present at latest echocardiogram in one patient. Freedom from moderate or severe AI at 51 months was 90 +/- 9.4%. There was no episode of endocarditis on follow-up. Univariate analysis demonstrated that no preoperative or intraoperative factor was a predictor for late reimplantation failure.
  
  
  CONCLUSIONS
  Reimplantation valve-sparing aortic root replacement in patients greater than 60 years old can be performed with satisfactory perioperative and midterm results. Long-term results are needed to define the durability of this technique and its role in this subset of patients.
authors.affiliation: Cardiac Surgery Department, Istituto Clinico Humanitas, Rozzano, Italy. fabrizio.settepani@humanitas.it
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Settepani
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
authors.forename: Marcello
authors.initials: M
authors.lastname: Bergonzini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Barbone
authors.forename: Enrico
authors.initials: E
authors.lastname: Citterio
authors.forename: Daniele
authors.initials: D
authors.lastname: Berwick
authors.forename: Roberto
authors.initials: R
authors.lastname: Gallotti
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria