Quality-of-life in valve-sparing aortic root replacement versus mechanical composite graft procedure

Abstract

Objectives: With the advent of aortic valve preservation in patients in need of aortic root replacement due to aneurysms or dissection, root replacement by means of a composite graft (MCG) became less common. Today, especially younger patients with a structural intact aortic valve will be forwarded to a aortic root procedure with preservation of the aortic valve (AVP). Despite obvious advantages, e.g. no need for oral anticoagulation, so far there is no data available that demonstrates advantages in quality of life (QoL) in this patient population. Methods: From 01/2004 to 03/2007 82 consecutive patients undergoing aortic root replacement with preservation of the aortic valve as proposed by David (n=20) or implantation of a mechanical composite graft (n=62) were included in the present study. Postoperative QoL was assesed using the short-form-36 health survey questionnaire (SF-36). Results: Anulo-aortic-ectasia was present in n=55 patients in the MCG group and n=19 in the AVP group. Dissections involving the aortic root were present in n=13 and n=1 patient respectively, ascending aortic aneurysms in n=56 and n=19 patients. In the MCG group n=2 patients died compared to n=0 in the AVP group. There were no significant difference in QoL between the MCG and the AVP groups as evaluated by the SF-36 (95±30 vs. 93±19, p=0.4) Conclusion: Despite anticipated advantages of valve sparing aortic root replacement compared to a mechanical composite graft at this point in time the reconstructive approach for surgery of the aortic root does not result in a measurabable benefit in terms of QoL.