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J Thorac Cardiovasc Surg 2001;122:270-277
© 2001 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease (ACD)

Valve-preserving aortic replacement: Does the additional repair of leaflet prolapse adversely affect the results?

From the Department of Thoracic and Cardiovascular Surgery, University Hospital Homburg, Germany.

Received for publication July 5, 2000. Revisions requested Oct 11, 2000; revisions received Jan 22, 2001. Accepted for publication Jan 25, 2001. Address for reprints: Hans-Joachim Schäfers, MD, PhD, Chairman, Department of Thoracic and Cardiovascular Surgery, University Hospital Homburg, 66424 Homburg/Germany (E-mail: chhjsc{at}med-rz.uni-sb.de).

Abstract

Objective: Valve-preserving aortic replacement has evolved into an accepted therapeutic option for aortic ectasia with morphologically intact leaflets. Some patients, however, exhibit additional leaflet prolapse. We compared the results of established valve-preserving techniques with those of the combination of valve-preserving aortic surgery and additional repair of leaflet prolapse.
Methods: Between October 1995 and March 2000, 99 patients underwent valve-preserving root replacement by means of root remodeling or valve reimplantation for acute dissection (n = 25), chronic dissection (n = 4), or aneurysm (n = 70). In group A (63 patients) either root remodeling (n = 49) or valve reimplantation (n = 14) was performed with a standard technique. In group B (36 patients) valvepreserving aortic replacement (remodeling, n = 31; reimplantation, n = 5) was combined with repair of leaflet prolapse in the presence of bicuspid (n = 24) or tricuspid (n = 12) valve anatomy. Additional replacement of the aortic arch was required more frequently in group A (group A, n = 43; group B, n = 14; P = .006); otherwise, the groups were comparable.
Results: Cardiopulmonary bypass (group A, 133 ± 31 minutes; group B, 117 ± 30 minutes; P = .006) and myocardial ischemia times (group A, 96 ± 25 minutes; group B, 88 ± 20 minutes; P = .05) were significantly longer in group A. Mortality was not significantly different between groups (group A, 4.8%; group B, 0%). One patient in each group underwent secondary valve replacement, and all other patients had stable valve function. Freedom from aortic regurgitation of grade 2 or greater after 48 months was 93.0% in both groups.
Conclusion: Repair of leaflet prolapse in conjunction with valve-preserving root replacement leads to midterm results that are equal to those of valve-preserving root replacement for morphologically intact leaflets.

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