[Replacement of the ascending aorta with aortic valve reimplantation - indication, technique, and results]

The main cause of aortic valve insufficiency is a dilatation of the sinotubular junction in patients with an ascending aortic aneurysm. Morphologically preserved aortic valve cusps represent an ideal condition for preservation and reconstruction of the aortic valve with an simultaneous replacement of the ascending aorta with a Dacron graft. This report presents the results of 140 patients, who underwent such surgery since 1993 in our institution. Indications for surgery, operative technique and different outcome parameters are discussed. Intra- and perioperative morbidity and mortality are low and quality of life excellent. Reoperation due to progressive aortic valve insufficiency was necessary in 2.1% of patients during follow-up. When compared with the standard operation (composite replacement utilizing a mechanical valve), patients with aortic valve reconstruction demonstrate similar results with regard to hospital stay and functional improvement. However, bleeding complications and thromboembolic events are significantly reduced in patients undergoing valve reconstruction. Due to these long-term results combined with excellent stress hemodynamics and improvement in LV function, aortic valve reconstruction currently represents our standard operative strategy in this patient group.