title: Surgical treatment of aortic valve regurgitation secondary to ascending aorta aneurysm: is adjunctive subcommissural annuloplasty necessary?
abstract: BACKGROUND
  Subcommissural aortic annuloplasty (SCA) has been recommended for treatment of functional aortic regurgitation (AR), but its association with sinotubular junction adjustment is still controversial.
  
  
  METHODS
  Sixty patients with moderate or severe functional AR secondary to proximal ascending aorta aneurysm operated on between May 2004 and December 2010 were reviewed. Forty patients underwent SCA and ascending aorta repair (SCA group; mean age, 65 ± 9 years) and 20 underwent ascending aorta repair alone (non-SCA group; mean age, 69 ± 8 years). Preoperative AR grades were comparable between groups (p = 0.9). Echocardiographic data at discharge and during follow-up (SCA group, 41 ± 13 months; non-SCA group, 46 ± 13 months) were analyzed.
  
  
  RESULTS
  Improvement of mean AR grade was better in the SCA group than in the non-SCA group at discharge (0.78 ± 0.9 vs 1.8 ± 0.1/4+, p = 0.0001) and at follow-up (0.44 ± 0.8 vs 2.4 ± 0.7/4+, p = 0.0001). Cox-regression analysis (odds ratio [95% confidence interval]) identified a higher residual AR at discharge (0.14 [0.012-0.37], p = 0.02) and the surgical technique, SCA or not (0.5 [0.03-0.899], p = 0.04), as predictors of more than grade 2/4+ AR at follow-up. Five-year freedom from more than grade 2/4+ AR was 94.4% ± 5.4% vs 58% ± 16% in SCA vs non-SCA (p = 0.02), respectively, and the survival rate was 95% ± 5% vs 89% ± 7.5% (p = 0.7). No valve stenosis was observed in the SCA group.
  
  
  CONCLUSIONS
  SCA is effective for treatment of functional AR, providing stable results even for significant AR. Our results suggest that it should be possibly associated to sinotubular junction adjustment. SCA seems to not impair normal aortic valve opening.
authors.affiliation: Division of Cardiac Surgery, Policlinico Tor Vergata, Tor Vergata University of Rome, Rome, Italy. mmvondocarlo@yahoo.fr
authors.forename: Charles
authors.initials: C
authors.lastname: Mve Mvondo
authors.forename: Paolo
authors.initials: P
authors.lastname: Nardi
authors.forename: Carlo
authors.initials: C
authors.lastname: Bassano
authors.forename: Fabio
authors.initials: F
authors.lastname: Bertoldo
authors.forename: Susanna
authors.initials: S
authors.lastname: Grego
authors.forename: Francesca
authors.initials: F
authors.lastname: D'Auria
authors.forename: Antonio
authors.initials: A
authors.lastname: Scafuri
authors.forename: Luigi
authors.initials: L
authors.lastname: Chiariello
mesh_terms: D000368:Aged; D001011:Aorta; D017545:Aortic Aneurysm, Thoracic / Q000150:complications*; D001022:Aortic Valve Insufficiency / Q000209:etiology* / Q000601:surgery*; D058385:Cardiac Valve Annuloplasty; D005260:Female; D006801:Humans; D008297:Male; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods