327 A standardized approach of aortic valve sparing combining root remodeling and aortic annuloplasty: impact of additional cusp repair?

Abstract

Aortic valve sparing is gaining increasing acceptance, however association with cusp repair may jeopardize its results. We studied patients operated electively with a standardized valve sparing approach with or without additional cusp repair. 125 patients with aortic root aneurysms underwent the Remodeling technique combined with a subvalvular annuloplasty in 10 centers (16 surgeons). Patients were analysed prospectively in 2 groups: without cusp repair (group 1, n=80) and with cusp repair (group 2, n=45) using plicating stitches (33), and/or running suture (10), and/or median raphe resection (12). Despite more severe preoperative aortic insufficiency (AI) in group 2, reoperation rate was not significantly higher (table). Five over 6 reoperations occurred during early experience. Cusp repair rate increased from 22.3% (15) in early period to 53.4% (27, p<0.01) since 2007, when aggressive management of cusp prolapse was started combining cusp free edges alignment with effective height measurement. Group 1 without cusp repair Group 2 with cusp repair Marfan 16 (20%) 2 (4.4%) * Bicuspid valves 7 (8.8%) 19 (42.2%) * Preoperative AI grade 1.66±1.2 (0-4) 2.42±1.2 (0-4) * Preoperative annulus diameter (mm) 27.5±1.6 (23-30) 28.6±2.1 (24-36) * Operative mortality 4 (5%) 1 (2.2%) Postoperative annulus diameter (mm) 20.1±2.1 (17-25) 21.3±1.1 (16-25) * Post-operative AI grade 0.3±0.4 (0-1) 0.2±0.4 (0-1) Mean follow-up (months) 36.1±21 (1-69) 17.5±16.9 (1-66) * Freedom from AI≥grade 2 64 (94.1%) 37 (92.5%) Reoperation for valve replacement 4 (5%) 2 (4.4%) Survival 72 (97.3%) 42 (95.5%) * p<0.05 Additional cusp repair does not affect early results of aortic valve sparing. Standardized management of root remodeling, cusp repair and aortic annuloplasty may improve feasibility and long term outcomes. This approach is currently evaluated versus mechanical valve replacement by CAVIAAR trial (Conservative Aortic Valve surgery for aortic Insufficiency and Aneurysms of the Aortic Root).