title: Reimplantation of the aortic valve at 20 years.
abstract: To provide additional information on clinical and echocardiographic outcomes after reimplantation of the aortic valve (RAV) in patients with aortic root aneurysm.
  
  
  
  All 333 patients who underwent RAV at our hospital between 1989 and 2012 were followed prospectively with periodical clinical assessment and echocardiography. The mean duration of clinical follow-up was 10.3 ± 6.8 years, and follow-up was completed within 2 years before this report.
  
  
  
  The study cohort had a mean patient age was 46 ± 5 years and was 78% male. The aortic root aneurysm was associated with Marfan syndrome in 124 patients, with bicuspid aortic valve in 45, with type A aortic dissection in 28, and with moderate to severe aortic regurgitation (AR) in 144. In addition to the RAV, 113 patients underwent another cardiac procedure owing to associated pathology. There were 4 early deaths (<90 days) and 35 late deaths. Survival at 15 and 20 years was 77.9 ± 2.9% and 72.4 ± 3.8%, respectively. Eleven patients developed moderate or severe AR during the follow-up; using interval censoring, 96.2 ± 1.0% were free from this event at 15 to 20 years. Six patients underwent reoperation on the aortic valve at 2 days to 23 years after RAV, including 1 patient for endocarditis and 5 patients for AR; freedom from reoperation at 15 to 20 years was 96.9 ± 1.3%. Seventeen patients sustained stroke or transient ischemic attacks; 92.5 ± 2.8% were free from thromboembolism at 15 and 20 years. Three patients developed infective endocarditis: 1 in the aortic valve and 2 in the mitral valve.
  
  
  
  RAV continues to provide excellent clinical results and stable aortic valve function during the second decade of observation.
authors.affiliation: Division of Cardiac Surgery of the Peter Munk Cardiac Centre at Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada. Electronic address: tirone.david@uhn.ca.
authors.forename: Tirone E
authors.initials: TE
authors.lastname: David
authors.affiliation: Division of Cardiac Surgery of the Peter Munk Cardiac Centre at Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: David
authors.affiliation: Division of Cardiac Surgery of the Peter Munk Cardiac Centre at Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Feindel
authors.affiliation: Division of Cardiac Surgery of the Peter Munk Cardiac Centre at Toronto General Hospital and the University of Toronto, Toronto, Ontario, Canada.
authors.forename: Cedric
authors.initials: C
authors.lastname: Manlhiot
mesh_terms: D000328:Adult; D017545:Aortic Aneurysm, Thoracic / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012092:Replantation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: David operation; aortic insufficiency; aortic root aneurysm; aortic valve-sparing operation