Aortic Valve Sparing Surgery as Alternative in Aortic Root Disease. Long-term Outcomes

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Abstract

Background: Since 1968, ascending aorta replacement with a valved conduit has been the standard practice for aortic root aneurysm. By the end of the 20th century, aortic valve sparing operation emerged and evolved as an alternative to aortic valve replacement.

Objective: The aim of this study was to report our experience with aortic valve sparing technique and its long -term outcomes.

Methods: A total of 116 consecutive cases with criteria of repairability operated on between 2005 and 2019 were analyzed. Preoperative transesophageal echocardiography (TEE) and computed tomography angiography (CTA) were used in combination to determine the aortic phenotype based on a previous anatomical and functional classification. Perioperative control was performed and conversion to aortic valve replacement was left to the discretion of the attending surgeon. Intraoperative variables, in-hospital morbidity and mortality, freedom from significant aortic regurgitation (AR) and reoperation in the clinical and echocardiographic follow-up were reported.

Results: Mean age was 56±15.6 years and 73% were men; 59% were asymptomatic, and the reason for the intervention was the
aortic diameter (52±11.7 mm) or progression of AR. After the procedure, 4% of the cases presented mild or trivial AR and 2 patients
required conversion to aortic valve replacement (1.7%). In hospital mortality was 0.9%. Actuarial survival was 88% at 10 years, and
79% were free from significant (moderate/severe) AR. Five cases underwent reoperation after a mean interval of 9.1 years and freedom from reoperation at 10 years was 90%. There were no major thromboembolic or bleeding events.

 Conclusion: Aortic valve sparing technique in the setting of aortic root disease is a feasible and safe option, and stable over time.