title: Aortic root aneurysm: principles of repair and long-term follow-up.
abstract: OBJECTIVE
  This study was undertaken to examine clinical and echocardiographic outcomes of aortic valve-sparing operations to treat aortic root aneurysms.
  
  
  METHODS
  From May 1988 to December 2007, a total of 228 patients underwent reimplantation of the aortic valve, and 61 underwent remodeling of the aortic root. Patients were followed up prospectively and had echocardiographic evaluation of valve function. Mean follow-up was 7.28 ± 4.33 years.
  
  
  RESULTS
  There were 5 operative and 26 late deaths. Survival at 12 years was 82.9 ± 3.7% and similar between types of operations. Age and aortic dissection were independent predictors of mortality. Seven patients have had reoperations on the aortic valve: 6 for aortic insufficiency and 1 for endocarditis. Five of these patients had undergone remodeling of the aortic root. Freedoms from reoperation at 12 years were 94.3% ± 2.6% among all patients, 90.4% ± 4.7% after remodeling, and 97.4% ± 2.2% after reimplantation (P = .09). Postoperatively, moderate aortic insufficiency developed in 14 patients (8 remodeling and 6 reimplantation) and severe aortic insufficiency in 5 (3 remodeling and 2 reimplantation). The remaining patients had mild, trace, or no aortic insufficiency. Freedoms from moderate or severe aortic insufficiency at 12 years were 86.8% ± 3.8% among all patients, 82.6% ± 6.2% after remodeling, and 91.0% ± 3.8% after reimplantation (P = .035). Only age-by 5-year increments-was an independent predictor of postoperative aortic insufficiency.
  
  
  CONCLUSIONS
  Aortic valve-sparing operations provide excellent patient survival and stable aortic valve function, particularly after reimplantation of the aortic valve.
authors.affiliation: Division of Cardiovascular Surgery of Peter Munk Cardiac Centre, Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada. tirone.david@uhn.on.ca
authors.forename: Tirone E
authors.initials: TE
authors.lastname: David
authors.forename: Manjula
authors.initials: M
authors.lastname: Maganti
authors.forename: Susan
authors.initials: S
authors.lastname: Armstrong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009864:Ontario; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012086:Reoperation; D012092:Replantation / Q000009:adverse effects / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D055815:Young Adult