Valve-Sparing Aortic Root Replacement in Congenital Aortopathy: Long-term Results

The objective of this study was to evaluate long-term outcomes for valve-sparing root replacement (VSRR) in patients with congenital aortopathy.

In 107 patients undergoing VSRR in an elective setting with preoperative data from 1998 to 2022, information about operative strategy and postoperative course was collected. Patients were assigned to the congenital aortopathy group if a genetic mutation was confirmed or if a bicuspid aortic valve was present and compared with patients with tricuspid aortic valve. Long-term follow-up was obtained through outpatient visits or by telephone interviews.

Fifty-two percent (n = 56) were congenital aortopathy patients. Patients without congenital aortopathy were older (P < .001) and had higher rates of preoperative hypertension (P = .030) and hyperlipidemia (P = .001). Early survival was excellent with no in-hospital death. Postoperative echocardiography showed a good result, with aortic regurgitation being mild or less in 93% (n = 99). Nevertheless, aortic valve reoperation was needed in 7% of patients. Rates of transient ischemic attacks (2%), strokes (5%), and need for pacemaker implantation (4%) during follow-up were comparable between groups. There was no difference in long-term outcome or need for aortic valve reoperation between the groups.

VSRR in congenital aortopathy patients has good long-term results. During follow-up, the rate of thromboembolic events might have an impact on optimal medical therapy.