Effects of preoperative aortic insufficiency on outcome after aortic valve-sparing surgery

Abstract

Background-The presence of significant preoperative aortic insufficiency (AI) or the need for cusp repair has been suggested as a risk factor for poorer outcomes after aortic valve (AV)-sparing surgery. We analyzed the influence of these factors on the mid-term outcomes of AV surgery. Methods and Results-Between 1996 and 2008, 164 consecutive patients underwent elective AV-sparing surgery. Severe preoperative AI (grade 5=3+) was present in 93 patients (57%), and 54 (33%) had a bicuspid valve. Root repair was performed with either the reimplantation (74%) or the remodeling (26%) technique, and cusp repair was performed in 90 patients (55%). Mean clinical follow-up was 57 months. Hospital mortality was 0.6%. Cusp repair was required in 52% of the patients with preoperative AI ≤2+ and in 57% of those with AI ≥3+ (P=0.6). Cusp repair was required more frequently in bicuspid versus tricuspid valves (91% versus 38%, P<0.001). Overall survival at 8 years was 88±8%. Freedom from AV reoperation at 8 years was similar with preoperative AI ≤2+ versus preoperative AI ≥3+ (89±11% versus 90±7%, P=0.7) and with versus without cusp repair (84±17% versus 92±8%, P=0.5). Freedom from recurrent AI (grade ≥3+) at 5 years was also similar between groups (90±10% versus 89±8%, P=0.9, and 90±8% versus 89±9%, P=0.8, respectively). By multivariate analyses, predictors of recurrent AI ≥2+ were preoperative left ventricle end-diastolic diameter and AI > 1 + on discharge echocardiography. Conclusions-With a systematic approach to cusp assessment and repair, AV-sparing surgery for root pathology has an acceptable mid-term outcome, irrespective of preoperative AI or need for cusp repair. © 2009 American Heart Association, Inc.