title: Valve-sparing aortic root replacement and remodeling with complex aortic valve reconstruction in children and young adults with moderate or severe aortic regurgitation.
abstract: OBJECTIVE
  The durability of valve-sparing aortic root procedures with aortic regurgitation due to leaflet disease is questioned. Here, we review our experience in combined aortic root and valve reconstruction in children and young adults.
  
  
  METHODS
  All valve-sparing aortic root procedures from 2000 to 2012 were reviewed, and patients with aortic valve repair beyond resuspension were included. Root procedures were classified as replacement with reimplantation, root remodeling, or aortic annular and sinotubular junction stabilization. The primary end point was structural valve deterioration, a composite of aortic valve reoperation and/or moderate or greater regurgitation at follow-up.
  
  
  RESULTS
  Thirty-four patients were included during the study period. The surgery consisted of reimplantation in 13 patients, remodeling in 16 patients, and annular and sinotubular junction stabilization in 5 patients. Valve repair consisted of leaflet procedures in 26 patients and subannular reduction in 15 patients. During a median follow-up of 4.2 months (range, 2 weeks-8 years), there were 5 reoperations for aortic valve replacement due to aortic regurgitation, and 2 patients presented with moderate or greater regurgitation. Freedom from structural valve deterioration was 70.1% ± 10.3% at 1 year and remained stable thereafter, although it was significantly worse in the reimplantation group (P = .039). A more severe degree of preoperative aortic regurgitation (P = .001) and smaller graft to aortic annulus ratio (P = .003) were predictors of structural valve deterioration.
  
  
  CONCLUSIONS
  Valve-sparing root and valve reconstruction can be done with low operative risk and allows valve preservation in most patients. These data should question the assumption that reimplantation is superior when associated with complex valve reconstruction.
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass; Department of Cardiovascular Surgery, Geneva University Hospitals and School of Medicine, Geneva, Switzerland.
authors.forename: Patrick O
authors.initials: PO
authors.lastname: Myers
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Pedro J
authors.initials: PJ
authors.lastname: del Nido
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Sitaram M
authors.initials: SM
authors.lastname: Emani
authors.affiliation: Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Gerald R
authors.initials: GR
authors.lastname: Marx
authors.affiliation: Department of Cardiac Surgery, Boston Children's Hospital and Harvard Medical School, Boston, Mass. Electronic address: christopher.baird@childrens.harvard.edu.
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Baird
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001011:Aorta / Q000503:physiopathology / Q000601:surgery*; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002648:Child; D018450:Disease Progression; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D059351:Organ Sparing Treatments / Q000009:adverse effects / Q000401:mortality; D012092:Replantation; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult