Valve-Sparing Aortic Root Replacement and Aortic Valve Repair

Abstract

Objectives: To evaluate our results of valve-sparing aortic root replacement and associated (multiple) valve repair. Methods: From September 2003 to March 2013, 99 patients had aortic valvesparing operations. Patient records and preoperative, postoperative and recent echocardiograms were reviewed. The median age was 36.3 (range 0.9- 68.6) years and 69 (69.7%) were male. Thirteen (13.1%) patients were younger than 18 years, the youngest being eight months. Fifty-three (53.5%) had Marfan syndrome, five (5.1%) other fibrous tissue disease, 16 (16.2%) bicuspid aortic valve and three (3.0%) had Fallot repair. The reimplantation (David) technique was used in all, with a straight vascular prosthesis in 15 (20-34 mm) and the Valsalva prosthesis in 84 (24-32 mm). Concomitant aortic valve repair was performed in 39 (39.4%), mitral valve repair in nine (9.1%), tricuspid valve repair in seven (7.1%), and aortic arch replacement in three (3.0%). Results: The mean follow-up was 2.4 +/- 2.2 years. Follow-up was complete in all. One 14-year-old patient died 1.3 years post-surgery of ventricular arrhythmia. One patient underwent reoperation for aneurysm of the proximal right coronary artery after 4.9 years and three patients required aortic valve replacement due to endocarditis after 0.13, 0.81, and 1.26 years. No thromboembolic complications occurred. Aortic insufficiency was absent or trivial in 95.9% at last follow-up. Conclusions: Results of valve-sparing root replacement are good, even in association with a high incidence of concomitant valve repair. Valve-sparing aortic root replacement can be performed at a very young age as long as an adult size prosthesis can be implanted.