Should aortic valve reimplantation be offered to patients with a large aorto-ventricular junction?

Abstract

Large aortic root aneurysms might increase leaflet stress and compromise aortic valve durability after the reimplantation technique. We analysed the impact of the preoperative aorto-ventricular junction (AVJ) diameter on the durability of the valve. Between March 2004 and January 2012, 150 patients underwent the David operation on the aortic root. We identified 47 patients with a preoperative AVJ >28 mm (Group A) and 103 patients with a diameter ≤ 28 mm (Group B). The mean follow-up was 44 ± 27 months. Both groups were compared regarding mortality, freedom from moderate or severe aortic valve regurgitation and freedom from reoperation. Early mortality was 1.3%. Actuarial survival at 1, 3 and 5 years was 97 ± 2, 94 ± 3 and 94 ± 3% for Group A, and 99 ± 1, 97 ± 1 and 94 ± 3% for Group B, respectively (P = 0.3). Two patients in Group B were reoperated for severe aortic regurgitation (AR). Actuarial freedom from reoperation at 1, 3 and 5 years was 100% for Group A, and 98 ± 1, 98 ± 1 and 96 ± 2% for Group B, respectively (P = 0.3). During the follow-up, 6 patients (3 in each group) developed AR ≥ Grade II. Therefore, actuarial freedom from AR grade II or greater at 1.3 and 5 years was 97 ± 2, 94 ± 4 and 87 ± 7% for Group A, and 99 ± 1, 97 ± 1 and 95 ± 2% for Group B (P = 0.3). The reimplantation technique shows excellent results. Medium-term stability of the aortic valve repair was not influenced by the preoperative aorto-ventricular junction diameter.