Valve-sparing aortic root repair without down-sizing of the annulus

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Cardiac Surgery

Background:

• Aortic root disease necessitates surgical intervention, with traditional methods often involving annulus downsizing.
• Patient-tailored aortic root repair aims to preserve native anatomy and improve functional outcomes.

Purpose of the Study:

• To evaluate the intermediate-term results of patient-tailored aortic root repair using the existing aortic annulus diameter.
• To assess the impact of sinus and cusp repair on functional outcomes in aortic root disease.

Main Methods:

• A cohort of 236 patients with aortic root disease underwent patient-tailored aortic root restoration between 2000 and 2009.
• Procedures included repair of 1, 2, or all 3 aortic sinuses, with concomitant cusp repair in 106 patients.
• Prospective data collection and intention-to-treat analysis were employed.

Main Results:

• Aortic valve repair was successful in 230 out of 236 patients.
• At a mean follow-up of 43 months, 216 patients had no or trivial aortic regurgitation (0/1+).
• Actuarial freedom from grade 3+ aortic regurgitation at 8 years was 95.2%; cusp repair was a significant predictor of residual regurgitation (OR 10.9).

Conclusions:

• Patient-tailored aortic root repair, adjusted to the native annulus, provides excellent and durable outcomes.
• Cusp disease is a critical factor influencing repair success, underscoring the importance of advanced cusp repair techniques.
• Reconstructive aortic valve surgery benefits from the development of reproducible cusp repair methods.