Different techniques for aortic valve repair and the associated root reconstruction - prospective long-term follow-up of the first 100 patients.
BACKGROUND
The advantages of aortic valve and aortic root reconstructive surgery include the provision of natural postoperative valve hemodynamics and the avoidance of prosthetic valve-related complications. A systematic approach based on functional classification of aortic regurgitation allows standardization and reproducibility. Its potential applicability, however, is limited by the relative lack of long-term follow-up data.


OBJECTIVE
To achieve the long term results of aortic valve and root repair in prospectively recruited group of 100 patients operated on during first seven years.


METHODS
Between the years 2003 and 2013, 225 consecutive patients (175 male, 50 female, mean age 51.3 years) with severe aortic regurgitation and aortic root enlargement underwent aortic valve repair or sparing surgery. The first 100 patients operated between 2003 and 2009 were prospectively enrolled in the study in order to achieve a 105-month follow-up. They underwent aortic valve repair and associated aortic root reconstruction. This prospective study is aimed at assessing the major endpoints of overall survival and freedom from reoperation. Additionally, log-rank testing for the risk factors associated with overall mortality, reoperation, and aortic valve repair failure was performed.


RESULTS
Among 225 patients, early mortality occurred in the case of 5 patients (2.2%), while 6 (2.5%) patients experienced early valve failure. In a prospective analysis performed on the first 100 patients, long-term results achieved with Kaplan-Meier analysis showed a survival rate of 93% and freedom from reoperation at the level of 91.3%. The risk factors for overall mortality included NYHA class, creatinine level, and perioperative root replacement as reimplantation. Redo operation was associated with bicuspid aortic valve and perioperative leaflet resection with pericardial patch repair.


CONCLUSIONS
One hundred and five month follow-up data from this prospectively analyzed cohort of patients prove that aortic valve repair associated with aortic root reconstruction can be performed with satisfactory results.
School of Medicine, Medical University of Silesia, Chair and Department of Cardiac Surgery, Katowice, Poland.
Marek J
MJ
Jasinski
School of Medicine, Medical University of Silesia, Chair and Department of Cardiac Surgery, Katowice, Poland.
Radosław
R
Gocol
School of Medicine, Medical University of Silesia, Chair and Department of Cardiac Surgery, Katowice, Poland.
Marcin
M
Malinowski
School of Medicine, Medical University of Silesia, Chair and Department of Cardiac Surgery, Katowice, Poland.
Damian
D
Hudziak
School of Medicine, Medical University of Silesia, Chair and Department of Cardiac Surgery, Katowice, Poland.
Piotr
P
Duraj
Department of Rehabilitation, Medical University of Silesia, Katowice, Poland.
Joanna
J
Frackiewicz
School of Medicine, Medical University of Silesia, Chair and Department of Cardiac Surgery, Katowice, Poland.
Tomasz
T
Kargul
School of Medicine, Medical University of Silesia, Chair and Department of Cardiac Surgery, Katowice, Poland.
Marek A
MA
Deja
School of Medicine, Medical University of Silesia, Chair and Department of Cardiac Surgery, Katowice, Poland.
Stanisław
S
Woś
aortic valve; aortic valve sparing surgery; reoperation