Early and Midterm Outcomes of Valve-Sparing Aortic Root Replacement-Reimplantation Technique.

Background:  Valve-sparing aortic root replacement (VSARR) is an increasingly popular alternative to traditional aortic root replacement for aortic root aneurysm disease with a normal aortic valve. We evaluated the early and midterm outcomes of VSARR-reimplantation technique (VSARR-RT) done at a single institution over a decade.

Materials And Methods:  We performed a retrospective study of all patients who underwent VSARR-RT between January 2004 and July 2014.

Results: A total of 85 patients underwent VSARR-RT. Median time to latest echocardiographic follow-up was 4 years (range: 15-72 months). Total observation time was 491 patient years. Mean age was 44.6 ± 14.3 years, and 13 (15%) were women. Thirty-nine (46%) patients had a connective tissue disorder and 6 (7%) had a bicuspid aortic valve. Thirty-three (39%) patients underwent concomitant procedures, including coronary artery bypass grafting ( = 9, 11%), mitral valve repair ( = 8, 9%), and aortic hemi-arch replacement ( = 7, 8%). There were no operative deaths or in-house mortality and no postoperative strokes. Kaplan-Meier analysis demonstrated survival of 99% (95% confidence interval [CI]: 97-100%) at 2 years and 98% (95% CI: 97-100%) at 8 years. Freedom from reoperation was 95.8% (95% CI: 91.2-100%) at 8 years. Freedom from endocarditis was 100% at 8 years. At the last echocardiographic follow-up, 95% of patients were free of severe aortic regurgitation (AR) and 82% free of moderate AR. Of the four patients who had severe AR, three underwent reoperations and received prosthetic valves and one is being clinically monitored.

Conclusion:  This study reports early and midterm outcomes after VSARR-RT at our institution, including those patients who underwent a VSARR-RT procedure combined with other procedures. Further follow-up remains necessary to determine long-term outcomes.