Ascending Aorta Aneurysm: What is the Risk of Replacing the Aortic Root?

pp. 250-256

Abstract

Background: In mildly dilated aortic root, the cost-benefit of replacing the sinuses of Valsalva with the resulting reimplantation of the coronary arteries compared with the alternative of preserving them is still a matter of debate.

Objective: The goal of this study was to analyze the postoperative and long-term morbidity and mortality of patients undergoing aortic root replacement versus aortic root surgery with sinus of Valsalva preservation.

Methods: Between 2002 and 2016, 426 patients underwent replacement of the ascending aorta. After excluding patients undergoing urgent procedures, genetic aortic diseases (except for bicuspid aortic valve), reoperations and surgery of the aortic arch, the study cohort was made up of 259 patients. The ascending aorta was replaced preserving the aortic root in 99 (38.2%) of these patients, and they were compared with the remaining 160 (61.8%) patients who underwent replacement of the sinuses of Valsalva.

Results: Patients with preservation of the aortic root were older, had higher percentage of female sex, higher EuroSCORE and
with greater incidence of bicuspid aortic valve and coronary artery disease. Cardiopulmonary bypass time was longer in the group undergoing aortic root replacement. There were no significant differences in in-hospital mortality between both groups (1% in the group with preservation of the aortic root vs. 3.1% in the group with replacement of the sinuses of Valsalva, p=0.272). Multivariate analysis showed that cardiopulmonary bypass time was a predictor of in-hospital mortality. Survival at 8 years was similar in both groups. There were no new operations due to complications in the aorta during follow-up. At multivariate analysis, age and mitral valve disease were identified as predictors of long-term mortality.

Conclusion: Replacement of the ascending aorta, either replacing the aortic root or preserving the sinuses of Valsalva, is a safe procedure, with low in-hospital morbidity and mortality. Preservation of the sinuses of Valsalva is not associated with greater long-term rate of events or mortality.