Ascending Aorta Aneurysm: What is the Risk of Replacing the Aortic Root?

Abstract

Background: In mildly dilated aortic root, the cost-benefit of replacing of the sinuses of Valsalva with reimplantation of thecoronary arteries or preserving them is still a matter of debate.Objective: The goal of this study was to analyze the postoperative and long-term morbidity and mortality of patients undergoingaortic root replacement versus aortic root surgery with sinuses of Valsalva preservation.Methods: Between 2002 and 2016, 426 patients underwent replacement of the ascending aorta. After excluding patients undergoingurgent procedures, genetic aortic diseases (except for bicuspid aortic valve), reoperations and surgery of the aortic arch,the cohort was made up of 259 patients. In 99 of them (38.2%) the ascending aorta was replaced, preserving the aortic root;these patients were compared with the remaining 160 (61.8%) patients who underwent replacement of the sinuses of Valsalva.Results: Patients undergoing preservation of the aortic root were older, had higher percentage of female sex, higher EuroSCOREand with greater incidence of bicuspid aortic valve and coronary artery disease. Cardiopulmonary bypass time was longer inthe group undergoing aortic root replacement. There were no significant differences in in-hospital mortality between bothgroups (1% in the group with preservation of the aortic root vs. 3.1% for replacement of the sinuses of Valsalva, p=0.272).Multivariate analysis showed that cardiopulmonary bypass was a predictor of in-hospital mortality. Survival at 8 years wassimilar in both groups. There were no new operations due to complications in the aorta during follow-up. At multivariateanalysis, age and mitral valve disease were identified as predictors of long-term mortality.Conclusion: Replacement of the ascending aorta, either replacing the aortic root or preserving the sinuses of Valsalva, is asafe procedure, with low in-hospital mortality. Preservation of the sinuses of Valsalva is not associated with greater rate ofevents or mortality at the long-term.