Impact of postoperative cusp configuration on midterm durability after aortic root reimplantation

The study aim was to examine the echocardiographic features associated with recurrent aortic regurgitation (AR) after valve-preserving aortic root reconstruction surgery.

Echocardiographic data from 86 patients who underwent aortic root replacement with or without cusp repair were retrospectively reviewed. An analysis was conducted of the height difference between the level of the ventriculoaortic junction (VAJ) and the central free margin of the cusp, defined as the effective height (EH), and the length from the aortic annulus to the edge of the body of Arantius, defined as the geometric height (GH), in addition to root dimensions (diameter of VAJ, sinus of Valsalva, and sinotubular junction).

All patients presented with < or = mild AR at discharge. After a median follow up duration of 46.4 months, the development of moderate AR or greater was observed in 14 patients. The overall actuarial freedom from moderate AR or greater, and freedom from reoperation at three and five years were 86.2 +/- 4.4% and 81.8 +/- 5.2%, and 94.0 +/- 3.0% and 91.8 +/- 3.6%, respectively. The postoperative EH (7.47 +/- 3.3 mm in > mild AR group, versus 8.81 +/- 2.1 mm in < or = mild AR group, p = 0.049), the incidence of postoperative eccentric jet (57.1% in > mild AR group versus 12.5% in < or = mild AR group, p = 0.0005) and cusp billowing (78.6% in > mild AR group versus 20.8% in < or = mild AR group, p < 0.0001) were significantly correlated with > mild AR in the follow up. There was also correlation between postoperative EH and the severity of recurrent AR at follow up (p = -0.33, p = 0.0019).

Objective information on cusp configuration, such as EH, should play an important role in stabilizing the outcome of valve-sparing surgery.