Valve-preserving surgery of the proximal aorta

Surgical treatment of proximal aortic disease currently offers a variety of surgical options. Traditionally, replacement of the proximal aorta has been performed with a composite graft in most cases; supracommissural aortic replacement was the only alternative if preservation of the native aortic valve was attempted. Valve-preserving root operations currently allow us to avoid the disadvantages of prosthetic heart valves and completely eliminate aortic root pathology.

Between 10/95 and 5/99, 219 patients were treated for proximal aortic disease. The diagnoses included degenerative disease (n=158), acute dissection (n=48), and chronic dissection (n=13). Composite replacement of valve and root (n=99) was used only in patients with significant degeneration or stenosis of the aortic valve. For near-normal root dimensions supracommissural aortic replacement (n=44) was chosen. Root remodeling (n=60) and reimplantation of the valve within a vascular graft (n=16) were performed for aortic valve regurgitation and root dilatation.

Overall hospital mortality was 5.7%; in elective operations, mortality was expectedly lower compared to emergency interventions (2.4% vs 16.3%; p<0.05). Hospital mortality for valve preserving procedures was similar (elective procedures 1.9%, emergency operations 9.5%). Two-year freedom from aortic regurgitation grade II or higher was 89% for remodeling and 92% for reimplantation. Freedom from reoperation for secondary and increasing regurgitation at two years was 96% for remodeling and 100% after reimplantation.

Using current techniques of valve preserving surgery, combined disease of the aortic valve, root, and extended segments of the aorta can be corrected without the disadvantages of prosthetic heart valves in the majority of patients. Further experience will define the relative role of the different operative modifications.