Abstract
Comparative analysis of early and late results of aortic root reconstruction with aortic valve sparing operations and the composite mechanical valve conduit replacement. From November 2002 to September 2009, 164 consecutive patients with mean age 54 ± 15 years, 115 male, underwent the aortic root reconstruction (125 mechanical valve conduit replacements and 39 valve sparing operations). Sixteen percent of patients had Marfan syndrome and 4.3% had bicuspid aortic valve. One hundred and forty-four patients (88%) were followed for a mean period of 41.1 ± 20.8 months. The hospital mortality was 4.9%, 5.6% in operations with valved conduits and 2.6% in the valve sparing procedures (P <0.05). There was no difference neither in survival (95% CI = 86% - 96%, P= 0.1) nor in reoperation-free survival (95% CI = 85% - 90%, P = 0.29). The survival free of complications such as bleeding, thromboembolism and endocarditis were favorable to the valve sparing operations, respectively (95% CI = 70% - 95%, P = 0.001), (95% CI = 82% - 95% P = 0.03) and (95% CI = 81% - 95%, P = 0.03). Multivariate analysis showed that creatinine greater than 1.4 mg/dl, Cabrol operation and renal dialysis were predictors of mortality, respectively, with occurrence chance of 6 (95% CI = 1.8 - 19.5, P = 0.003), 12 (95% CI = 3 - 49.7, P = 0.0004) and 16 (95% CI = 3.6 - 71.3, P = 0.0002). The aortic root reconstruction has a low early and late mortality, high survival free of complications and low need for reoperation. During the late follow-up, valve sparing aortic root reconstructions presented fewer incidences of bleeding, thromboembolic events and endocarditis.
Highlights
The surgical procedures used to reconstruct the aortic root are independent of morphological or etiopathogenic characteristics of the diseases that affect this aortic segment
The main conceptual difference of surgical techniques for aortic root lies in the use of a valved conduit or the aortic valve preservation, with their respective advantages and disadvantages
Since Bentall & De Bono [1] introduced the operation to replace the ascending aorta and the aortic valve for a valved conduit, several adaptations to this original technique have been proposed [2,3,4,5]. As an alternative, another concept for the treatment of this aortic segment arose, and it would be replaced associated with the aortic valve preservation
Summary
The surgical procedures used to reconstruct the aortic root are independent of morphological or etiopathogenic characteristics of the diseases that affect this aortic segment. Since Bentall & De Bono [1] introduced the operation to replace the ascending aorta and the aortic valve for a valved conduit, several adaptations to this original technique have been proposed [2,3,4,5] After mastering these operations, as an alternative, another concept for the treatment of this aortic segment arose, and it would be replaced associated with the aortic valve preservation. Sarsam & Yacoub [6] initially, and later, David & Feindel [7] have proposed techniques for aortic root reconstruction with the preservation of native aortic valve In these patients, the valve leaflets do not show significant primary changes, but they may present secondary changes to the dilation of the aortic ring, in addition to abnormalities similar to those in the related aortic wall, which could limit the longevity of this procedure [8,9,10]. The purpose of this study is to analyze the early and late results of the aortic root reconstruction with a valved conduit, and with the aortic valve preservation
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