Five-year experience with valve sparing surgery for aortic root aneurysms

Background: The aim of this study was to analyze the mid-term results of aortic root reconstruction. Methods: Between September 1995 and March 2001, 32 patients (25 males, 7 females, median age 58 21 years) underwent aortic root reconstruction as described by T. David. Indications for operation were aortic insufficiency with ascending aortic aneurysm in 27 patients, and acute aortic dissection (Stanford type A) in 5 patients. In all patients the native valve was preserved and suspended inside a tubular prosthesis with reimplantation of the coronary arteries. In 10 patients the classic reconstruction technique was modified by shaping a "Neosinus." Results: There was one perioperative death due to myocardial infarction. Two patients suffered a stroke. 26 patients were followed up 12 months postoperatively. 22 out of 26 patients were in NYHA functional class I, 2 patients in class II and the remaining 2 in class III. Three patients died in the postoperative period. Six patients had trivial AR, 4 mild and 1 moderate regurgitation. There were no thromboembolic events during follow up. The mean transvalvular gradient was 3.5+/-2.2 mmHg. Compared to a normal cohort of patients (n=20), resuspended aortic valves opened (26.4+/-5.8 vs. 61.3+/-22.1 cm/sec, p<0.0001) and closed (22.8+/-6.9 vs. 57.9+/-22.3) at a higher speeds and also showed shorter opening (0.053+/-0.12 vs. 0.023+/-0.09 sec, p < 0.0001) and closing times (0.051+/-0.07 vs. 0.23+/-0.07 cm/sec) of the aortic leaflets. Conclusions: Aortic valve reimplantation is a reliable technique able to reduce long term complications when compared to conventional composite graft replacement of the aortic root. Altered leaflet opening and closing dynamics do not impair midterm durability.