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J Thorac Cardiovasc Surg 2006;132:347-354
© 2006 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease |
Divisions of Cardiovascular Surgery and Cardiology of Toronto General Hospital and University of Toronto, Toronto, Ontario, Canada.
Read at the Eighty-sixth Annual Meeting of The American Association for Thoracic Surgery, Philadelphia, Pa, April 29-May 3, 2006.
Received for publication February 5, 2006; revisions received March 19, 2006; accepted for publication March 23, 2006. * Address for reprints: Tirone E. David, MD, 200 Elizabeth St 4N-457, Toronto, Ontario M5G 2C4, Canada (Email: tirone.david{at}uhn.on.ca).
OBJECTIVES: To examine the results of aortic valve sparing for aortic root aneurysm.
METHODS: Two hundred twenty consecutive patients who had aortic valve sparing for aortic root aneurysm were prospectively studied with annual clinical assessments and echocardiography. Their mean age was 46 ± 15 years, 40% had Marfan syndrome, 17% had aortic dissection, and 7% had bicuspid aortic valve. Reimplantation of the aortic valve was performed in 167 patients and remodeling of the aortic root in 53. Aortic cusp repair was performed in 80 patients, and reinforcement of the free margin of one of the cusps with a fine polytetrafluoroethylene (Gore-Tex) suture in 48. The mean follow-up was 5.2 ± 3.7 years and it was complete.
RESULTS: There were 3 operative and 13 late deaths. Patients' survival at 10 years was 88% ± 3%. Age older than 65 years, advanced functional class, and ejection fraction less than 40% were independent predictors of death. Moderate aortic insufficiency developed in 7 patients and severe insufficiency in 6. Freedom from moderate or severe aortic insufficiency at 10 years was 85% ± 5% for all patients, but it was 94% ± 4% after reimplantation and 75% ± 10% after remodeling (P = .04). Five patients required aortic valve replacement; the freedom from valve replacement at 10 years was 95% ± 3%. One case of endocarditis developed 11 years postoperatively. At the latest follow-up, 88% of the patients were in functional class I, and 10% were in class II.
CONCLUSIONS: Aortic valve-sparing operation is associated with low rates of valve-related complications. The probability of late aortic insufficiency was lower after the reimplantation procedure than after remodeling in our experience.
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