title: Valve-sparing aortic root replacement†.
abstract: OBJECTIVE
  To evaluate our results of valve-sparing aortic root replacement and associated (multiple) valve repair.
  
  
  METHODS
  From September 2003 to September 2013, 97 patients had valve-sparing aortic root replacement procedures. Patient records and preoperative, postoperative and recent echocardiograms were reviewed. Median age was 40.3 (range: 13.4-68.6) years and 67 (69.1%) were male. Seven (7.2%) patients were younger than 18 years, the youngest being 13.4 years. Fifty-four (55.7%) had Marfan syndrome, 2 (2.1%) other fibrous tissue diseases, 15 (15.5%) bicuspid aortic valve and 3 (3.1%) had earlier Fallot repair. The reimplantation technique was used in all, with a straight vascular prosthesis in 11 (26-34 mm) and the Valsalva prosthesis in 86 (26-32 mm). Concomitant aortic valve repair was performed in 43 (44.3%), mitral valve repair in 10 (10.3%), tricuspid valve repair in 5 (5.2%) and aortic arch replacement in 3 (3.1%).
  
  
  RESULTS
  Mean follow-up was 4.2 ± 2.4 years. Follow-up was complete in all. One 14-year old patient died 1.3 years post-surgery presumably of ventricular arrhythmia. One patient underwent reoperation for aneurysm of the proximal right coronary artery after 4.9 years and 4 patients required aortic valve replacement, 3 of which because of endocarditis after 0.1, 0.8 and 1.3 years and 1 because of cusp prolapse after 3.8 years. No thrombo-embolic complications occurred. Mortality, root reoperation and aortic regurgitation were absent in 88.0 ± 0.5% at 5-year follow-up.
  
  
  CONCLUSIONS
  Results of valve-sparing root replacement are good, even in association with a high incidence of concomitant valve repair. Valve-sparing aortic root replacement can be performed at a very young age as long as an adult size prosthesis can be implanted.
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, Netherlands Department of Paediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands d.r.koolbergen@amc.nl.
authors.forename: David R
authors.initials: DR
authors.lastname: Koolbergen
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Johan S J
authors.initials: JS
authors.lastname: Manshanden
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Berto J
authors.initials: BJ
authors.lastname: Bouma
authors.affiliation: Department of Paediatric Cardiology, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Nico A
authors.initials: NA
authors.lastname: Blom
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Barbara J M
authors.initials: BJ
authors.lastname: Mulder
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Bas A J M
authors.initials: BA
authors.lastname: de Mol
authors.affiliation: Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, Netherlands Department of Paediatric Cardiology, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Hazekamp
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000601:surgery*; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D059351:Organ Sparing Treatments / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies
keywords: Aortic valve preservation; Aortic valve repair; Valve-sparing root replacement