Long-term outcomes after aortic root repair using selective sinus replacement.

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Surgery

Background:

• Aortic root aneurysms and dissections often require surgical intervention.
• Valve-sparing root repair aims to preserve native aortic valve function.
• Long-term outcomes of anatomic restoration techniques are crucial for patient management.

Purpose of the Study:

• To evaluate the long-term functional results of valve-sparing aortic root repair.
• To assess the efficacy of selective sinus replacement in restoring aortic root anatomy.
• To identify factors influencing long-term valve function after aortic root repair.

Main Methods:

• A total of 669 patients underwent valve-sparing root repair over an 18-year period.
• Selective sinus replacement was used, with 1, 2, or 3 sinuses replaced in 209, 234, and 226 patients, respectively.
• Follow-up averaged 7.1 years, with assessment of aortic insufficiency and root dimensions.

Main Results:

• Freedom from relevant aortic insufficiency (grade 3+) was 98% at 5 years, 97% at 10 years, and 94% at 15 years.
• No significant changes in the repaired root's form or size were observed postoperatively.
• Cusp prolapse/pseudo-prolapse was the sole independent risk factor for recurrent moderate (grade 2+) insufficiency (HR 3.258).

Conclusions:

• Patient-tailored aortic root repair with sinus replacement yields excellent long-term functional results.
• The underlying aortic root pathology and annulus size did not significantly impact outcomes.
• Aortic cusp pathology is the primary determinant of long-term valve function after repair.