Should the annulus be fixed in aortic valve-sparing root replacement with remodeling?

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery
• Aortic Valve Surgery

Background:

• Aortic regurgitation may recur if the aortic root dilates after valve-sparing root reconstruction with remodeling.
• The potential for aortic root dilation after remodeling has not been clearly demonstrated.

Purpose of the Study:

• To investigate whether the aortic root dilates after native aortic valve-sparing root reconstruction with remodeling.
• To assess changes in aortic dimensions and valve function post-remodeling without ventriculo-aortic junction fixation.

Main Methods:

• Retrospective analysis of 15 patients undergoing aortic valve-sparing root remodeling without ventriculo-aortic junction fixation.
• Sutures were passed through the fibrous annulus.
• Measurements included aortic root diameters (ventriculo-aortic junction, neosinus of Valsalva, sinotubular junction), aortic regurgitation, and effective aortic valve height.
• Median follow-up was 7.3 years.

Main Results:

• No significant dilation of the ventriculo-aortic junction (VAJ) was observed postoperatively (p=0.75).
• The sinus of Valsalva and sinotubular junction showed significant increases in diameter (p=0.0013 and p=0.0003, respectively).
• Effective aortic valve height and degree of aortic regurgitation did not significantly change postoperatively (p=0.08 and p=0.1558, respectively).

Conclusions:

• Native aortic valve-sparing root reconstruction with remodeling, without ventriculo-aortic junction fixation, did not result in significant ventriculo-aortic junction dilation.
• Fixation of the annulus may not be required in remodeling procedures for patients without preoperative annular dilation.