Aortic root reconstruction through valve-sparing operation: critical analysis of 11 years of follow-up.
BACKGROUND
The composite mechanical valve conduit replacement is the standardized operation for aneurysms of the aortic root. The objective of this study is to evaluate the long-term surgical results of aortic valve-preserving procedures to the root reconstruction.


METHODS
From 1996 to 2008, 54 consecutive patients underwent two different techniques of valve-sparing aortic root operation (40 Yacoub operations and 14 David operations). Mean age was 48 +/- 14 years (range 17 to 74). 36 patients (66.7%) were male and 16 (29.6%) experienced Marfan's syndrome. The mean Euroscore was 4 +/- 1.25. The mean follow up time was 4.1 years (from 49 days to 10.9 years). Clinical and echocardiographic parameters were analysed. T-Student paired test, the McNemar Non Parametric test and the Kaplan-Meyer Outcome Curves have been used.


RESULTS
The hospital mortality was 5.6% and the average hospitalization time was 9+/-4 days. One non related late death (2%) was reported. The actuarial survival and freedom from reoperation were respectively 94.4% and 96% within 11 years of follow-up. There were benefits in reduction of functional class (P=0.002; 78% CF I), in reduction of aortic regurgitation (P<0.001; 78% with or without discrete reflux), in reduction of systolic and diastolic diameters, end-sytolic and end-diastolic volumes of left ventricle (respectively P=0.004; P<0.0001; P=0.036 and P<0.001). Two (3.9%) patients required aortic valve replacement due to severe aortic regurgitation during this same period. No thromboembolic, endocarditis or bleeding events were reported during the follow-up.


CONCLUSIONS
The valve-sparing operation for aortic root aneurysms is an effective alternative to the use of a mechanical valve conduit replacement.
Dias
Ricardo Ribeiro
RR
Heart Institute of the Faculty of Medicine of the University of São Paulo, São Paulo, SP, Brazil. ricardo.dias@incor.usp.br
Mejia
Omar V
OV
Carvalho
Edemir V
EV
Lage
Diogo O C
DO
Dias
Altamiro Ribeiro
AR
Pomerantzeff
Pablo M A
PM
Mady
Charles
C
Stolf
Noedir A G
NA
D000293:Adolescent; D000328:Adult; D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D004812:Epidemiologic Methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult