Ascending aortic replacement with aortic valve reimplantation.

Area of Science:

• Cardiovascular Surgery
• Aortic Surgery
• Heart Valve Repair

Background:

• Aortic root aneurysms often necessitate aortic valve repair alongside ascending aorta replacement.
• The long-term durability of native aortic valve reimplantation in Dacron grafts remains a subject of debate due to mechanical stress on valve cusps.

Purpose of the Study:

• To evaluate the durability and outcomes of native aortic valve reimplantation within a Dacron tube graft for aortic root aneurysms.
• To identify factors critical for the success of this aortic valve repair technique.

Main Methods:

• A cohort of 75 patients underwent ascending aorta replacement with aortic valve repair between July 1993 and November 1998.
• Follow-up included clinical and echocardiographic assessments at 6- to 12-month intervals over a cumulative period of 137 patient-years.
• Patients with Marfan syndrome (28%) and aortic dissection (15%) were included; 23% required concomitant aortic arch replacement.

Main Results:

• No operative mortality was observed. Late mortality occurred in 3% of patients.
• 3% of patients required reoperation for progressive aortic insufficiency within 14 months.
• The majority of patients (over 96%) experienced no or only mild aortic insufficiency, with repairs remaining stable for up to 65 months (mean 22 months).

Conclusions:

• Native aortic valve reimplantation within a Dacron graft is an effective treatment for selected patients with aortic root aneurysms.
• Meticulous repair ensuring perfect initial valve cusp coaptation and minimal or trace aortic insufficiency is essential for durable outcomes.