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J Thorac Cardiovasc Surg 2007;134:909-915
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Aortic root remodeling: Ten-year experience with 274 patients

Department of Thoracic and Cardiovascular Surgery, University Hospital of Saarland, Homburg/Saar, Germany.

Received for publication February 4, 2007; revisions received April 10, 2007; accepted for publication May 11, 2007.

^_* Address for reprints: Prof Dr H.-J. Schäfers, Department of Thoracic and Cardiovascular Surgery, University Hospital of Saarland, 66421 Homburg/Saar, Germany. (Email: h-j.schaefers{at}uniklinikum-saarland.de).

Objectives: Dilatation of the aortic root with concomitant aortic regurgitation can be treated by valve-preserving surgery. We have consistently chosen root remodeling rather than reimplantation whenever the aortoventricular junction was not dilated. We have analyzed our 11-year experience with root remodeling.

Methods: Between October 1995 and October 2006, 274 patients (201 male; 73 female, aged 59 ± 15 years) were treated by root remodeling in the presence of a preserved aortoventricular diameter (<30 mm). Acute aortic dissection was present in 46 patients. The valve anatomy was tricuspid in 193 and bicuspid in 81 patients. Cusp disease was additionally corrected in 173 (63%) patients. Follow-up was complete in 99%. Cumulative follow-up was 1045 patient-years (mean of 4.0 ± 2.7 years).

Results: Hospital mortality was 3.6% (elective 3.1%; emergency 6.5%). One patient had endocarditis 2 months postoperatively and subsequently underwent valve replacement. Freedom from aortic regurgitation of grade II or more was 91% and 87% at 10 years for bicuspid and tricuspid aortic valves. Nine patients required reoperation: in 6 patients the valve was replaced and in 3 patients rerepaired. Freedom from reoperation was 96% at 5 and 10 years, and freedom from valve replacement was 98% at 5 and 10 years. A comparison of 3 operative periods (1995–1998, 1999–2002, and 2003–2006) showed that with increasing experience cusp prolapse was diagnosed and corrected more frequently (8/49 = 17%; 62/105 = 59%; 103/108 = 82%; P < .0001), and repair stability significantly improved over time (P = .007).

Conclusions: Root remodeling leads to durable restoration of aortic valve function in both tricuspid and bicuspid valve anatomy. Aggressive correction of cusp prolapse seems to have a beneficial effect on aortic valve competence.

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