HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Tirone E. David Christopher M. Feindel Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by David, T. E. Articles by Maganti, M. Search for Related Content PubMed PubMed Citation Articles by David, T. E. Articles by Maganti, M. Related Collections Great vessels Valve disease

J Thorac Cardiovasc Surg 2006;132:347-354
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Long-term results of aortic valve-sparing operations for aortic root aneurysm

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.

This article has been cited by other articles:

				L. de Kerchove, D. Glineur, A. Poncelet, M. Boodhwani, J. Rubay, W. Dhoore, P. Noirhomme, and G. El Khoury Repair of aortic leaflet prolapse: a ten-year experience Eur. J. Cardiothorac. Surg., October 1, 2008; 34(4): 785 - 791. [Abstract] [Full Text] [PDF]

				G. D. Pearson, R. Devereux, B. Loeys, C. Maslen, D. Milewicz, R. Pyeritz, F. Ramirez, D. Rifkin, L. Sakai, L. Svensson, et al. Report of the National Heart, Lung, and Blood Institute and National Marfan Foundation Working Group on Research in Marfan Syndrome and Related Disorders Circulation, August 12, 2008; 118(7): 785 - 791. [Full Text] [PDF]

				L. Labrousse, M. Montaudon, S. Black, and C. Deville Right Coronary Sinus Fixation Through a Right Ventriculotomy for David's Procedure. Ann. Thorac. Surg., June 1, 2008; 85(6): 2150 - 2152. [Abstract] [Full Text] [PDF]

				S. S. Fazel, H. R. Mallidi, R. S. Lee, M. P. Sheehan, D. Liang, D. Fleischman, R. Herfkens, R. S. Mitchell, and D. C. Miller The aortopathy of bicuspid aortic valve disease has distinctive patterns and usually involves the transverse aortic arch. J. Thorac. Cardiovasc. Surg., April 1, 2008; 135(4): 901 - 907.e2. [Abstract] [Full Text] [PDF]

				T. E. David Aortic Valve Repair and Aortic Valve Sparing Operations Card. Surg. Adult, January 1, 2008; 3(2008): 935 - 948. [Full Text]

				D. Aicher, F. Langer, H. Lausberg, B. Bierbach, and H.-J. Schafers Aortic root remodeling: Ten-year experience with 274 patients. J. Thorac. Cardiovasc. Surg., October 1, 2007; 134(4): 909 - 915. [Abstract] [Full Text] [PDF]

				A. Moritz and T. Aybek Reply to the Editor J. Thorac. Cardiovasc. Surg., September 1, 2007; 134(3): 824 - 824. [Full Text] [PDF]

				M. Matsumori, H. Tanaka, Y. Kawanishi, T. Onishi, K. Nakagiri, T. Yamashita, K. Okada, and Y. Okita Comparison of distensibility of the aortic root and cusp motion after aortic root replacement with two reimplantation techniques: Valsalva graft versus tube graft Interactive CardioVascular and Thoracic Surgery, April 1, 2007; 6(2): 177 - 181. [Abstract] [Full Text] [PDF]

				T. E. David, C. M. Feindel, S. Armstrong, and M. Maganti Replacement of the ascending aorta with reduction of the diameter of the sinotubular junction to treat aortic insufficiency in patients with ascending aortic aneurysm J. Thorac. Cardiovasc. Surg., February 1, 2007; 133(2): 414 - 418. [Abstract] [Full Text] [PDF]

				T. E. David, C. M. Feindel, G. D. Webb, J. M. Colman, S. Armstrong, and M. Maganti Aortic Valve Preservation in Patients With Aortic Root Aneurysm: Results of the Reimplantation Technique Ann. Thorac. Surg., February 1, 2007; 83(2): S732 - S735. [Abstract] [Full Text] [PDF]

				D. C. Miller Valve-Sparing Aortic Root Replacement: Current State of the Art and Where Are We Headed? Ann. Thorac. Surg., February 1, 2007; 83(2): S736 - S739. [Full Text] [PDF]

				H. Jeanmart, L. de Kerchove, D. Glineur, J.-M. Goffinet, I. Rougui, M. Van Dyck, P. Noirhomme, and G. El Khoury Aortic Valve Repair: The Functional Approach to Leaflet Prolapse and Valve-Sparing Surgery Ann. Thorac. Surg., February 1, 2007; 83(2): S746 - S751. [Abstract] [Full Text] [PDF]

				H. F. Lausberg and H.-J. Schafers Valve sparing aortic replacement - root remodeling MMCTS, November 10, 2006; 2006(1110): 1982. [Abstract] [Full Text] [PDF]