Valve-Sparing Root Replacement Following Congenital Heart Disease Repair: Lesion-Specific Technical Considerations

Area of Science:

• Cardiovascular Surgery
• Congenital Heart Disease
• Aortic Root Surgery

Background:

• Valve-sparing root replacement (VSRR) is gaining traction for aortic root dilatation post-congenital heart disease (CHD) repair.
• Technical nuances of VSRR based on specific prior CHD repairs are not well-documented.

Purpose of the Study:

• To describe the technical aspects and outcomes of VSRR in adult patients with a history of specific congenital heart repairs.
• To highlight lesion-specific anatomical considerations for successful VSRR.

Main Methods:

• Case series of three adult patients undergoing VSRR after prior repairs: perimembranous ventricular septal defect (VSD) closure, annulus-sparing tetralogy of Fallot repair, and Ross procedure.
• Detailed description of surgical techniques, focusing on dissection and cusp management.

Main Results:

• VSRR was technically successful in all three cases.
• Dissection of the right coronary cusp (RCC) sinus was uncomplicated in patients with prior VSD closure.
• No RCC prolapse or specific RCC repair was needed; minor noncoronary cusp plication sufficed.
• Reimplantation in the Ross procedure case followed the autograft suture line without difficulty.

Conclusions:

• VSRR can be safely performed following various congenital heart repairs.
• Understanding lesion-specific anatomy is crucial for optimizing VSRR outcomes in this patient population.
• Careful surgical planning tailored to prior repair type ensures effective VSRR.