title: Should aortic valve reimplantation be offered to patients with a large aorto-ventricular junction?
abstract: OBJECTIVE
  Large aortic root aneurysms might increase leaflet stress and compromise aortic valve durability after the reimplantation technique. We analysed the impact of the preoperative aorto-ventricular junction (AVJ) diameter on the durability of the valve.
  
  
  METHODS
  Between March 2004 and January 2012, 150 patients underwent the David operation on the aortic root. We identified 47 patients with a preoperative AVJ >28 mm (Group A) and 103 patients with a diameter ≤ 28 mm (Group B). The mean follow-up was 44 ± 27 months. Both groups were compared regarding mortality, freedom from moderate or severe aortic valve regurgitation and freedom from reoperation.
  
  
  RESULTS
  Early mortality was 1.3%. Actuarial survival at 1, 3 and 5 years was 97 ± 2, 94 ± 3 and 94 ± 3% for Group A, and 99 ± 1, 97 ± 1 and 94 ± 3% for Group B, respectively (P = 0.3). Two patients in Group B were reoperated for severe aortic regurgitation (AR). Actuarial freedom from reoperation at 1, 3 and 5 years was 100% for Group A, and 98 ± 1, 98 ± 1 and 96 ± 2% for Group B, respectively (P = 0.3). During the follow-up, 6 patients (3 in each group) developed AR ≥ Grade II. Therefore, actuarial freedom from AR grade II or greater at 1.3 and 5 years was 97 ± 2, 94 ± 4 and 87 ± 7% for Group A, and 99 ± 1, 97 ± 1 and 95 ± 2% for Group B (P = 0.3).
  
  
  CONCLUSIONS
  The reimplantation technique shows excellent results. Medium-term stability of the aortic valve repair was not influenced by the preoperative aorto-ventricular junction diameter.
authors: Department of Cardiac Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain. apforteza@yahoo.es
authors: Alberto
authors: A
authors: Forteza
authors: Jorge
authors: J
authors: Centeno
authors: Maria Jesus
authors: MJ
authors: López
authors: Violeta
authors: V
authors: Sánchez
authors: Enrique
authors: E
authors: Perez
authors: Beatriz
authors: B
authors: López
authors: Juan Jose
authors: JJ
authors: Rufilanchas
authors: Pedro
authors: P
authors: Muñoz
authors: Jose
authors: J
authors: Cortina
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000033:anatomy & histology; D001014:Aortic Aneurysm / Q000601:surgery; D001021:Aortic Valve / Q000033:anatomy & histology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000209:etiology; D006348:Cardiac Surgical Procedures / Q000379:methods*; D000075202:Contraindications; D005260:Female; D006352:Heart Ventricles / Q000033:anatomy & histology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D012086:Reoperation; D012092:Replantation / Q000379:methods*