Twenty-five Years of Root Remodeling for Root Aneurysm and Tricuspid Aortic Valve.

Abstract

The aim of this retrospective study was to assess the long-term results of root remodelling with tricuspid aortic valves and the effects of concomitant cusp repair and annuloplasty. Between 10/1995 and 12/2021, 684 patients with root aneurysm and regurgitant tricuspid valves were treated by root remodelling. Mean age was 56.5(SD: 14) years, 538(77.6%) were male. Relevant aortic regurgitation was present in 68.3%. Concomitant procedures were performed in 374 patients. The long-term results were analyzed. Mean follow-up of 7.2(SD: 5.3) years (median 6.6 years); it was 95% complete (4934.4 patient-years). Cusps prolapse was repaired in 83%, an annuloplasty was added in 353 instances (51.6%). Hospital mortality was 2.3%, survival was 81.7% (SD: 1.2) and 55.7 (SD: 5.8) at 10 and 20 years; age and measurement of effective height were independent predictors for death.Freedom from AI II was 90.5 (SD : 1.9) at 10 years and 76.7(SD : 4.5) at 20 years. Cusp repair of all cusps showed a lower freedom from recurrent AI≥II at 10 years(p < 0.001). Suture annuloplasty showed a lower freedom from recurrent AI II at 10 years (p = 0.07).Freedom from reoperation was 95.5(SD : 1.1) and 92.8(SD: 2.8) at 10 and 20 years. The addition of an annuloplasty showed no difference(p = 0.236). Cusp repair had no effect on valve durability(p = 0.390). Root remodelling leads to good long-term stability. The addition of cusp repair improves the valve stability over time. The addition of suture annuloplasty improve early valve competency; it showed no effect on freedom from reoperation up to 10 years.