Reduction of the sinotubular junction in patients undergoing ascending aortic replacement with coexisting aortic insufficiency.

Background And Aim Of The Study: Dilatation of the STJ may cause consequent aortic insufficiency (AI) in patients with normal aortic valve, in patients with ascending aortic aneurysm. In this study, we analyzed the results of ascending aorta replacement with STJ diameter reduction to correct consequent AI in patients with ascending aortic aneurysm.

Methods: Forty-five consecutive patients who had ascending aortic aneurysm underwent replacement of ascending aorta with reduction of the STJ diameter to correct AI. Mean age of the patients was 61.3 ± 5.2. Twenty-six (57.8%) were female. Six patients had arch aneurysm. Postoperative echocardiographic studies were performed at discharge and annually thereafter. The mean duration of follow-up was 4.6 ± 2.9 years.

Results: Hospital mortality rate was 4.9% (n = 2). Three patients died during follow-up. Three patients had late recurrence of AI that was caused by aortic root dilatation. One of these patients required aortic valve replacement because of severe aortic insufficiency. The five-year survival and survival free from aortic insufficiency were 91.4%± 5.0% and 91.2%± 5.1%, respectively.

Conclusions: Reduction of the diameter of STJ can be used to treat AI in patients with ascending aortic aneurysm with nearly normal aortic cusps. Midterm results of this procedure are encouraging.