Long-term results and cusp dynamics after aortic valve resuspension for aortic root aneurysms.
BACKGROUND
This study reports our 10-year experience with the David technique and technical modifications to create neosinuses.


METHODS
From January 1996 to February 2009, the David procedure was performed in 151 consecutive patients in our department. Mean age was 59 ± 13 years (range, 22 to 78 years). All patients had ascending aortic aneurysm (mean diameter, 6.0 ± 1.1 cm); 59 patients had additional arch aneurysm. Fifty-four patients underwent the standard David procedure, with a pseudosinus created in 42 patients (28%) and neosinuses in 55 patients (36%) by plicating the base and sinotubular junction of the tube graft. Patients were followed up prospectively and had echocardiography studies before discharge and at follow-up. Mean follow-up was 5 years (584 patient-years).


RESULTS
There were 6 in-hospital and 16 late deaths. Reexploration for bleeding was necessary in 27 patients (17%). Three patients had perioperative neurologic events, and 2 patients experienced them during follow-up. Five patients required late aortic valve replacement. Cardiovascular events were the cause of late death in 6 patients. Valve gradients were low, with only 2 patients having significant valve incompetence remaining. Echocardiography results showed a more physiologic, reduced velocity of cusp movement in the neosinus group compared with the conventional technique.


CONCLUSIONS
Aortic valve resuspension is a durable procedure. Only 4.8% experienced a relevant valve dysfunction. Other valve-related complications were minimal, with three observed neurologic events and one endocarditis. Creation of the neosinus lead to more physiologic leaflet dynamics and facilitated geometric adaptation.
Department of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University, Frankfurt/Main, Germany. farhad@bakhtiary.de
Farhad
F
Bakhtiary
Nadejda
N
Monsefi
Eva
E
Herrmann
Maria
M
Trendafilow
Tayfun
T
Aybek
Aleksandra
A
Miskovic
Anton
A
Moritz
D000328:Adult; D000368:Aged; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery*; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D002423:Cause of Death; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011446:Prospective Studies; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome