Durability and survival following valve-sparing root replacement: a longitudinal study

To evaluate immediate and long-term outcomes of valve-sparing root replacement (VSRR) for patients with dilated aortic roots.

This observational study included all patients undergoing VSRR between June 2009 to October 2024, systematically documenting patient demographics, pre-operative characteristics, surgical details, and valve morphology. The primary outcome was all-cause mortality, with secondary endpoints including valve-related complications and reintervention rates.

The cohort consisted of 91 patients, predominantly males (81.3%), with a mean age of 38.5 ± 14.2 years. Of these, 83 (91.2%) patients were diagnosed with aortic aneurysm, and 25(27.4%) had connective tissue disorder. The valve morphology analysis revealed that 76 (83.5%) patients had tricuspid aortic valves, and 73 (80.2%) presented with moderate-severe aortic regurgitation. Sixty-one (67%) straight tubular Dacron grafts and 30(33%) Valsalva grafts were used.Surgical complications were relatively low, with 5 (5.4%) patients requiring re-exploration. Serious adverse events were infrequent, and 1(1.1%) patient had a stroke, 3(3.2%) developed acute kidney injury requiring dialysis, and 1(1.1%) patient needed a tracheostomy. Additional complications included complete heart block or permanent pacemaker implantation in 2 patients (2.1%), and extracorporeal membrane oxygenation (ECMO) use in 1 patient (1.1%). The 30-day mortality was 3 (3.2%). The mean survival was 12.7 years; 95% confidence interval (CI): 11.7 to 13.7 years. The cumulative survival rates at 1, 5 and 10-years was 95%, 93%, and 86%. Freedom from moderate/ severe aortic regurgitation at 1, 3, and 5 years was 88%, 88% and 77% respectively.

The excellent survival and low complication rates suggest VSRR as a viable surgical approach for patients with aortic root pathologies.

The online version contains supplementary material available at 10.1007/s12055-025-02104-5.