title: Use of the Valsalva graft and long-term follow-up.
abstract: OBJECTIVE
  The Valsalva graft is a specifically designed Dacron graft that, on implantation and pressurization, generates pseudosinuses of Valsalva. We reviewed a multicenter experience of the reimplantation procedure with the Valsalva graft in patients with aneurysms involving the aortic root.
  
  
  METHODS
  A total of 278 patients underwent valve-sparing aortic root replacement using the Valsalva graft at 4 different Italian cardiac surgery centers and were studied by clinical assessment and echocardiography. Of the 278 patients, 220 were men (79%), with a mean age of 56 ± 15 years. Of the patients, 42 (15%) had Marfan syndrome, 31 (11%) had a bicuspid aortic valve, 13 (5%) had acute aortic dissection, and 136 (49%) had grade 3 or 4+ aortic insufficiency. Concomitant cardiac procedures were performed in 78 patients (28%). Additional aortic leaflet repair was necessary in 25 patients (9%). The mean crossclamp time was 120 ± 27 minutes.
  
  
  RESULTS
  There were 5 (1.8%) operative and 5 (1.8%) late deaths. The mean follow-up was 52 ± 28 months (range, 2-112 months) and was 100% complete. The cumulative actuarial survival was 95.2% (268 patients). A total of 32 patients (11%) had grade 3 to 4+ aortic insufficiency, and 17 of these required late aortic valve replacement (range, 3-78 months). At 10 years of follow-up, the freedom from aortic valve reoperation rate was 91%, and the rate of freedom from residual aortic insufficiency not needing reoperation was 88%.
  
  
  CONCLUSIONS
  The reimplantation type of valve-sparing procedure can be facilitated by the use of the Valsalva graft and can be performed with satisfactory perioperative and midterm results. How an optimal root reconstruction will affect the second decade of follow-up has yet to be determined.
authors.affiliation: Department of Cardiac Surgery, European Hospital, Rome, Italy. depauli@tin.it
authors.forename: Ruggero
authors.initials: R
authors.lastname: De Paulis
authors.forename: Raffaele
authors.initials: R
authors.lastname: Scaffa
authors.forename: Saverio
authors.initials: S
authors.lastname: Nardella
authors.forename: Daniele
authors.initials: D
authors.lastname: Maselli
authors.forename: Luca
authors.initials: L
authors.lastname: Weltert
authors.forename: Fabio
authors.initials: F
authors.lastname: Bertoldo
authors.forename: Davide
authors.initials: D
authors.lastname: Pacini
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Settepani
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tarelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Gallotti
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
authors.forename: Luigi
authors.initials: L
authors.lastname: Chiariello
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011093:Polyethylene Terephthalates; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012086:Reoperation; D012092:Replantation / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012850:Sinus of Valsalva / Q000000981:diagnostic imaging / Q000601:surgery*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D011093:Polyethylene Terephthalates