Outcome of valve sparing root replacement for diverse indications

Area of Science:

• Cardiovascular Surgery
• Aortic Valve Disease
• Congenital Heart Disease

Background:

• Valve-sparing aortic root replacement (VSRR) is a complex procedure with varying outcomes depending on patient complexity.
• Understanding mid-term results in diverse patient cohorts, including those with bicuspid aortic valve (BAV), connective tissue disorders (CTD), aortic dissection (AD), and congenital heart disease (CHD), is crucial for surgical decision-making.

Purpose of the Study:

• To evaluate the mid-term outcomes of VSRR using the reimplantation technique in a mixed-risk patient population.
• To assess survival rates, freedom from aortic valve replacement (AVR), and freedom from significant aortic insufficiency (AI) or reoperation.
• To identify potential risk factors for adverse outcomes in patients undergoing VSRR.

Main Methods:

• A retrospective analysis of 174 patients who underwent VSRR with the reimplantation technique between 2005 and 2017.
• Data collected included patient demographics, preoperative conditions (BAV, CTD, AD, CHD, AI), concomitant aortic valve repair, and follow-up events.
• Kaplan-Meier survival analysis and Cox regression were used to evaluate outcomes and risk factors.

Main Results:

• Zero 30-day mortality was observed.
• Five-year estimates showed 96% survival, 98% freedom from AVR, and 97% freedom from >= moderate AI or reoperation.
• No significant differences in outcomes were found based on the presence of BAV, CTD, leaflet repair, or preoperative AI.

Conclusions:

• VSRR demonstrates excellent mid-term efficacy and safety in a diverse patient cohort, even in centers with limited annual VSRR volume.
• Patient-specific factors like BAV, CTD, or the need for valve repair did not negatively impact long-term outcomes.
• VSRR is a viable and effective option for managing aortic root pathology across a broad spectrum of patients.