Mid-term Outcomes after Aortic Valve Reimplantation with a Straight versus Valsalva Graft

To compare mid-term hemodynamic performance and durability of valve-sparing aortic root reimplantation (VSRR) using a Straight versus Valsalva graft.

From 1/1/2000-12/1/2023, 1,495 adults without endocarditis underwent VSRR at Cleveland Clinic, of whom 838 (56%) received a Straight graft and 657 (44%) a Valsalva graft. Mean aortic valve gradient, aortic regurgitation grade, aortic valve reoperation, and survival were compared in 365 propensity-matched patient pairs (730 patients).

After matching (Straight vs Valsalva), operative mortality was 0.56% versus 0.28% (P=.56). At 5 years, mean aortic valve gradients were 6.6 versus 6.3 mmHg (P=.46) and prevalence of moderate or severe aortic regurgitation 12% versus 9.1% (P=.38). Straight grafts were associated with higher freedom from aortic valve reoperation overall (96% vs 94%, P=.045) and for structural valve deterioration (98% vs 95%, P[constant phase]=.019), at a rate of 0.27%/year versus 0.83%/year at 5 years. Concomitant aortic valve repair was more prevalent in patients receiving a Valsalva graft (37% vs 44%, P=.059), which carried a higher risk of reoperation (P[log-rank]=.0023; after adjusting for the confounding effect of concomitant aortic valve repair, P for risk of reoperation was .082).

Despite its increasing use in more complex and higher-risk patients, VSRR demonstrates excellent mid-term durability and hemodynamic performance, regardless of graft type. Higher risk of reoperation with Valsalva grafts likely reflects case mix and technical complexity.