Valve-sparing aortic root replacement is an attractive option for aortic root aneurysms, avoiding valve prosthesis disadvantages and complications:the challenge for surgeons is to guarantee a durable aortic valve repair. In this study we present our early and long term results, identifying pre- and intra-operative risk factors for reoperation at follow up.
From March 2002 to December 2017, 201 consecutive patients underwent conservative operation of the aortic valve and aortic root replacement, according to David reimplantation technique. Bicuspid aortic valve (BAV), Marfan syndrome and type A acute aortic dissection (AADA)-patients were included in the study. Patients were retrospectively evaluated with clinical and echocardiographic studies. Mean follow up time was 81.87 ± 59.74 months.
Mean age was 49.7 ± 15.2 years. Overall in-hospital mortality was 3%, if we consider only elective cases 0.5%. At discharge, aortic regurgitation was mild or lower in 87.1% of the patients. AADA (p = 0.000) and arch surgery (p = 0.004) are risk factors for early mortality. At 10 years, survival was 90.9%. At 5 years and 10 years, freedom from reoperation for severe aortic regurgitation was 92.7% and 86.2% respectively. Freedom from moderate to severe aortic regurgitation at 5 and 10 years was 97.2% and 84.4% respectively. At multivariate analysis, preoperative severe aortic regurgitation (p = 0.91), BAV (p = 0.32), Marfan syndrome (p = 0.10),cusps repair (p = 0.12) were not statistically significative risk factors.
Our experience showed that aortic valve repair and valve-sparing aortic root surgery is a safe and effective procedure, and it can be performed with satisfactory short- and long-term results. It's important to refer the patients to high-volume center. We didn’t find risk factors for valve repair-failure.
Cardio-Toraco-Vascolare, Policlinico di S.Orsola, Università di Bologna Bologna