Valve-preserving aortic root reconstruction: A comparison of techniques

Background and aim of the study: Controversy exists with regard to the indications and technique for valve-preserving aortic root reconstruction. Here, the authors' clinical experience with three techniques is reported. Methods: Between October 1994 and October 2000, 71 patients (46 men, 25 women; median age 53 years; range: 21-81 years) underwent aortic root reconstruction with preservation of the aortic valve and replacement of ascending aorta. Factors that affected survival and need for subsequent aortic valve replacement were analyzed using univariate analysis. Results: Indications for operation were chronic aneurysm in 65 patients, acute dissection in five, and chronic aneurysm with dissection in one patient. Forty patients were asymptomatic. Presenting symptoms included shortness of breath in 16 patients, chest pain in 14 and transient ischemic attacks in one patient. Twenty patients had Marfan syndrome. The reimplantation technique was performed in 52 patients, remodeling technique in 14, and remodeling with sinus graft root replacement technique in five. Postoperative echocardiography demonstrated absent to :mild aortic insufficiency in 63 patients. Operative mortality was 2.8%. Actuarial survival was 84.1% at 5 years; freedom from reoperation was 88.8% and 78.9% at one and three years, respectively. Eleven patients (21.2%) repaired by the implantation technique required aortic valve replacement secondary to aortic valve insufficiency. By univariate analysis, the necessity of aortic cusp repair (p = 0.0009), aortic annulus size >25 mm (p = 0.04), and male gender (p = 0.04) were predictors for subsequent aortic valve replacement. Conclusion: Aortic valve-preserving surgery is possible with a low morbidity and mortality. The authors' experience shows a high failure rate in males with a large annulus needing aortic cusp repair and undergoing the reimplantation technique.