VALVE SPARING AORTIC ROOT RECONSTRUCTION: DOES GRAFT SIZING MATTER?

Abstract

Aortic root reconstruction with valve sparing techniques have gained widespread acceptance for treatment of patients with aortic root aneurysm with/without aortic insufficiency. Several graft sizing strategies have been described with variable efficacy. Our study aims to evaluate the influence of graft sizing on outcomes after root reconstruction. Between 2008 and 2015, 95 consecutive patients underwent aortic valve sparing root reconstruction by three cardiac surgeons at three different institutions. Mean age was 50 ± 16 years, 82 (86.3%) were male. Twenty-four (25.5%) patients had confirmed connective tissue disease. Acute type A aortic dissection was the clinical presentation in 9 (9.5%) patients and greater then or equal to moderate aortic insufficiency was present in 28 (35.4%) patients. Aortic valve morphology was identified as tricuspid, bicuspid and unicuspid in 64 (68.1%), 29 (30.8%), and 1 (1.1%) of patients, respectively. Maximum aortic diameter was 53.3 ± 9.1 mm. Mean cardiopulmonary bypass time was 251 ± 67 minutes, aortic cross-clamp time was 209 ± 50 minutes, and hypothermic circulatory arrest time was 39 ± 34 minutes in patients who underwent arch replacement. Mean follow-up was 21.6 ± 15.6 months. In-hospital/30-day mortality occurred in one patient. Mean graft size was 30.6 ± 2.5 mm, with ≥ 30 mm in 65.3% patients and < 30 mm in 34.7%. Cuspal plication techniques were employed in 45.9%. Aortic insufficiency decreased from 1.79 ± 1.9 (0-4) preoperatively to 0.35 ± 0.56 (0-2) postoperatively. Multivariate regression analysis demonstrated no significant effect of graft sizing on freedom from ≥ moderate aortic insufficiency. Median ICU and hospital length of stay were 1 and 5 days, respectively. Freedom from reoperation at 30 days/in-hospital, 1 year and 5 years was 100%, 100%, and 98%, respectively. Survival at 30 days/in-hospital, 1 year and 5 years was 99%, 99%, and 99%, respectively. Graft size selection appears to have little impact on the risk of postoperative aortic insufficiency. Other factors are likely more importantly related to risk of aortic insufficiency and warrant further investigation.