title: Aortic regurgitation after valve-sparing aortic root replacement: modes of failure.
abstract: BACKGROUND
  Despite the positive clinical results of valve-sparing aortic root replacement, little is known about the causes of reoperations and the modes of failure.
  
  
  METHODS
  From October 1999 to June 2010, 101 patients underwent valve-sparing aortic root replacement using the David reimplantation technique. The definition of aortic root repair failure included the following: (1) intraoperative conversion to the Bentall procedure; (2) reoperation performed because of aortic regurgitation; and (3) aortic regurgitation equal to or greater than a moderate degree at the follow-up. Sixteen patients were considered to have repair failure. Three patients required intraoperative conversion to valve replacement, 3 required reoperation within 3 months, and another 8 required reoperation during postoperative follow-up. At initial surgery 5 patients had moderate to severe aortic regurgitation, 6 patients had acute aortic dissections, 3 had Marfan syndrome, 2 had status post Ross operations, 3 had bicuspid aortic valves, and 1 had aortitis. Five patients had undergone cusp repair, including Arantius plication in 3 and plication at the commissure in 2.
  
  
  RESULTS
  The causes of early failure in 6 patients included cusp perforation (3), cusp prolapse (3), and severe hemolysis (1). The causes of late failure in 10 patients included cusp prolapse (4), commissure dehiscence (3), torn cusp (2), and cusp retraction (1). Patients had valve replacements at a mean of 23 ± 20.9 months after reimplantation and survived.
  
  
  CONCLUSIONS
  Causes of early failure after valve-sparing root replacement included technical failure, cusp lesions, and steep learning curve. Late failure was caused by aortic root wall degeneration due to gelatin-resorcin-formalin glue, cusp degeneration, or progression of cusp prolapse.
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Oka
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Okita
authors.forename: Masamichi
authors.initials: M
authors.lastname: Matsumori
authors.forename: Kenji
authors.initials: K
authors.lastname: Okada
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Minami
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Munakata
authors.forename: Takeshi
authors.initials: T
authors.lastname: Inoue
authors.forename: Akiko
authors.initials: A
authors.lastname: Tanaka
authors.forename: Toshihito
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Atsushi
authors.initials: A
authors.lastname: Omura
authors.forename: Takuo
authors.initials: T
authors.lastname: Nomura
mesh_terms: D000293:Adolescent; D001021:Aortic Valve / Q000601:surgery; D001022:Aortic Valve Insufficiency / Q000209:etiology*; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017211:Treatment Failure