Aortic valve preservation in patients with aortic root aneurysm: Results of the reimplantation technique

Background. A study was conducted to determine the long-term results of aortic valve reimplantation to treat aortic root aneurysm. Methods. Prospective follow-up with clinical assessments and echocardiography was done of 167 consecutive patients who had reimplantation of the aortic valve as treatment of aortic root aneurysm. Their mean age was 45 +/- 15 years, 78% were men, 38% had Marfan syndrome, 14% had aortic dissection, and 7% had bicuspid aortic valve. The aortic valve was reimplanted into a straight Dacron (Dupont, Wilmington, DE) tube in 89 patients and in a Dacron tube with creation of neoaortic sinuses in 78. Aortic cusp repair was performed in 66 patients, and the free margin was reinforced with a fine Gore- Tex suture (W. L. Gore & Assoc, Flagstaff, AZ) in 36. The mean follow-up was 5.1 +/- 3.8 years and was 100% complete. Results. There were two operative and six late deaths. Survival at 10 years was 92% +/- 3%. Moderate aortic insufficiency developed in 3 patients, and severe developed in 2. Freedom from moderate or severe aortic insufficiency was 94% +/- 4% at 10 years. Two patients required aortic valve replacement. Freedom from aortic valve replacement was 95% +/- 4% at 10 years. At the latest follow-up, 90% of the patients were in New York Heart Association functional class I and 10% were in class II. Conclusions. Reimplantation of the aortic valve to treat patients with aortic root aneurysm is associated with excellent long- term survival and low rates of valve-related complications. Reimplantation of the aortic valve is a durable type of aortic valve repair.