Aortic annulus does not dilate over time after aortic root remodeling with or without annuloplasty

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery
• Aortic Valve Surgery

Background:

• Aortic root remodeling is a surgical technique to treat aortic root dilation.
• A potential drawback of aortic root remodeling is the lack of annular stabilization.
• External suture annuloplasty has been proposed to improve annular stabilization.

Purpose of the Study:

• To investigate the late annular size after aortic root remodeling.
• To compare the effectiveness of external suture annuloplasty versus no annuloplasty in maintaining aortic annulus size over time.

Main Methods:

• A retrospective study of 241 patients undergoing aortic root remodeling.
• Annular size was measured preoperatively, before discharge, and at least 2 years postoperatively.
• Patients were analyzed with or without external suture annuloplasty, with propensity-score matching used for comparison.

Main Results:

• Annular size significantly decreased post-repair and remained stable long-term (T0: 27.4 mm, T2: 24.2 mm).
• While annuloplasty initially showed less effective reduction, annular size was similar at follow-up (23.8 mm with annuloplasty vs. 25.1 mm without).
• No significant difference in freedom from >10% annular size increase at 4 years was observed between groups (91% with annuloplasty vs. 93% without).

Conclusions:

• Aortic annulus rarely dilates long-term after remodeling.
• External suture annuloplasty may normalize annular size in cases of dilatation and enhance cusp coaptation.
• Even without annuloplasty, the aortic annulus tends to decrease in size post-repair if the aortic valve remains competent.