Aortic valve disease with ascending aortic aneurysm: Impact of concomitant root-sparing (supracoronary) aortic replacement in nonsyndromic patients.
The purpose of the study was to assess the anticipated incremental risk of a concomitant aortic resection performed with an aortic valve replacement.



Patients who underwent aortic valve replacement with root-sparing ascending replacement were compared with those who underwent isolated aortic valve replacement using propensity score matching (81 pairs; mean age, 63 ± 11 years [root-sparing ascending replacement] vs 64 ± 14 years). To evaluate the impact of the technique at distal site, 71 pairs of those undergoing root-sparing ascending replacement also were matched by propensity score according to distal anastomosis performed clamped and open under deep hypothermic circulatory arrest.



Operative mortality was equal between the root-sparing ascending replacement and isolated aortic valve replacement groups. No significant difference was found regarding postoperative morbidities, such as bleeding, renal failure, stroke, and length of stay, except prolonged ventilation was found after root-sparing procedures (P = .028). Survival estimation showed no difference between the groups. Comparing the patients undergoing root-sparing ascending replacement with clamped and opened distal anastomosis revealed a prolonged ventilation requirement (7% vs 3%; P = not significant) in the open group. Operative mortality was 0% in both groups, and midterm survival was comparable.



The concomitant replacement of the aorta in root-sparing fashion is associated with an excellent operative outcome and adds no additional risk to aortic valve replacement in elective and non-high-risk patients. If the distal anastomosis is performed in an open fashion, while the operative mortality is still very low, morbidities are slightly higher, but midterm survival remains comparable.
Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn; Department of Cardiac Surgery, University Hospital Munich, Ludwig Maximilian University, Munich, Germany.
Sven
S
Peterss
Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn.
Paris
P
Charilaou
Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn.
Julia
J
Dumfarth
Department of Economics and Department of Preventive Medicine, Stony Brook University, Stony Brook, NY.
Yupeng
Y
Li
Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn.
Rohan
R
Bhandari
Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn.
Maryann
M
Tranquilli
Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn; Department of Economics and Department of Preventive Medicine, Stony Brook University, Stony Brook, NY.
John A
JA
Rizzo
Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn; Department of Surgical Diseases #2, Kazan State Medical University, Kazan, Russia.
Bulat A
BA
Ziganshin
Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Conn. Electronic address: john.elefteriades@yale.edu.
John A
JA
Elefteriades
D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D015996:Survival Rate; D016896:Treatment Outcome
aneurysm; aortic root; aortic valve replacement; surgical risk