title: Mid-term results after sinutubular junction remodelling with aortic cusp repair.
abstract: OBJECTIVE
  An ascending aortic aneurysm with aortic valve regurgitation (AR) may be treated by sinutubular junction remodelling (STJR) with aortic cusp repair if the root diameter is preserved. We analysed the outcome of STJR with cusp repair.
  
  
  METHODS
  Between 1995 and 2010, 1094 patients underwent valve-preserving surgery. Of these, 560 individuals with root replacement, 128 patients with acute aortic dissection and 262 patients with preoperative AR ≤ II were excluded. The remaining 144 patients (mean age 56.0 ± 17.0 years, 103 males) underwent STJR ± cusp repair for ascending aortic aneurysm and AR ≥ III. In all, sinus dimensions were preserved according to the following criteria: maximum diameter ≤42 mm in bicuspid aortic valve (BAV, n = 59) and unicuspid aortic valve (UAV, n = 27), and ≤45 mm in tricuspid aortic valves (TAV, n = 58). In BAV, right-left (n = 52) and right-non-coronary (n = 7) cusp fusions were seen. To evaluate the influence of valve morphology, patients were divided into two groups: TAV and non-TAV. The patients with non-TAV were younger (P < 0.01) and had less concomitant cardiac surgery (P < 0.01). The mean follow-up was 25.9 ± 22.0 months.
  
  
  RESULTS
  Early mortality was 2.1% (n = 3). The causes of death were cardiac (n = 1), respiratory (n = 1) and mesenteric ischaemia (n = 1). Higher age was the predictor of early mortality by multivariate analysis (P = 0.04, hazard ratio 13.2). Overall 5-year survival was 93.9 ± 2.9% (TAV, 82.8 ± 10.2%; non-TAV, 98.5 ± 1.5%; P = 0.02). Causes of late death were cardiac (n = 1), respiratory (n = 1) and carcinoma (n = 1). Freedom from recurrent AR ≥ III at 5 years was 80.1 ± 7.7% (TAV, 97.0 ± 3.0%; non-TAV, 73.4 ± 8.7%; P = 0.02). By multivariate analysis, only aortoventricular junction (AVJ) > 28 mm (P < 0.01, hazard ratio 9.7) was a predictor of recurrent AR. Freedom from reoperation at 5 years was 81.9 ± 7.8% (TAV, 97.0 ± 3.0%; non-TAV, 76.6 ± 8.8%; P < 0.05). The causes of reoperation (five re-aortic valve repairs and four valve replacements) were dehiscence of pericardial patch (n = 7) and recurrent cusp prolapse (n = 2). By multivariate analysis, only AVJ > 28 mm was a significant predictor for reoperation (P < 0.01, hazard ratio 11.6).
  
  
  CONCLUSIONS
  STJR with cusp repair is a useful technique in patients with an ascending aortic aneurysm and relevant AR. Although the dilated AVJ is a risk of recurrent AR and reoperation, concomitant cusp repair is associated with an acceptable mid-term outcome.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery,  University Hospital of Saarland, Homburg/Saar,  Germany.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Asano
authors.forename: Takashi
authors.initials: T
authors.lastname: Kunihara
authors.forename: Diana
authors.initials: D
authors.lastname: Aicher
authors.forename: Hazem
authors.initials: H
authors.lastname: El Beyrouti
authors.forename: Svetlana
authors.initials: S
authors.lastname: Rodionycheva
authors.forename: Hans-Joachim
authors.initials: HJ
authors.lastname: Schäfers
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery; D001014:Aortic Aneurysm / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012850:Sinus of Valsalva / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome