Aortic Valve-Sparing Operations: Early and Midterm Results

Abstract

Aortic valve-sparing operations have provided very good clinical outcomes. However, there is still a debate about valve durability because of the absence of the Valsalva sinuses, and various techniques have been proposed to reproduce the native anatomy of the aortic root. We reviewed our total experience with aortic valve-sparing operations to determine early and midterm outcomes. Between July 2001 and August 2004, 85 patients underwent valve-sparing operations. There were 67 (78.8%) male and 18 (21.2%) female patients with a mean age of 58.8 +/- 14.6 years. Sixty-five patients with an aortic root aneurysm underwent the David I reimplantation technique, and a Gel-weave Valsalva graft was used in 57 patients. Twenty patients with an ascending aortic aneurysm underwent replacement of the ascending aorta with sinotubular junction reduction. There were 3 in-hospital deaths (3.5%) and 2 late deaths. Two of 4 patients with acute aortic dissection died. The 3-year survival for patients with an aortic root aneurysm was 95.4% +/- 2.6%, and for patients with an ascending aortic aneurysm it was 89.2% +/- 7.3 (P = .464). Seven patients developed 3 to 4+ aortic insufficiency, and 5 of them required aortic valve replacement. The 3-year freedom rate from grade 3 to 4 aortic insufficiency was 88.9% +/- 5.2% for patients with an aortic root aneurysm and 88.2% +/- 7.8% for those with an ascending aortic aneurysm. At 3 years, the freedom rates from late aortic valve replacement were 92.2% +/- 4.9% in the aortic root aneurysm group and 88.2% +/- 7.8% in the ascending aortic aneurysm group. Aortic valve-sparing operations showed excellent results in patients electively operated on for aortic root ectasia, and the results in acute aortic dissection were very disappointing. The Gelweave Valsalva prosthesis demonstrated ease of implantability and good reproduction of the pseuodosinuses. Long-term follow-up is necessary to determine if this graft will enhance the function and increase the durability of the aortic valve.