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J Thorac Cardiovasc Surg 2009;137:314-319
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Factors associated with the development of aortic valve regurgitation over time after two different techniques of valve-sparing aortic root surgery

^a Clinic of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
^b Department of Mathematics, School of Science and Technology, University of Sussex, Brighton, United Kingdom
^c Clinic for Thoracic, Heart, and Thoracic Vascular Surgery, University of Wuerzburg, Germany

Received for publication March 27, 2008; revisions received June 17, 2008; accepted for publication August 5, 2008.

^_* Address for reprints: Hans-H. Sievers, MD, Clinic of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany, Ratzeburger Allee 160, 23538 Luebeck, Germany. (Email: h.sievers{at}herzchirurgie-luebeck.de).

Objective: Early results after aortic valve-sparing root reconstruction are excellent. Longer-term follow-up, especially with regard to aortic valve function, is required for further judgment of these techniques.

Methods: Between July of 1993 and September of 2006, 108 consecutive patients (mean age 53.0 ± 15.8 years) underwent the Yacoub operation (group Y) and 83 patients underwent the David operation (group D). Innovative multilevel hierarchic modeling methods were used to analyze aortic regurgitation over time.

Results: In general, aortic regurgitation increased with time in both groups. Factors associated with the development of a significant increase in aortic regurgitation were Marfan syndrome, concomitant cusp intervention, and preoperative aortic anulus dimension. In Marfan syndrome, the initial aortic regurgitation was higher in group Y versus group D (0.56 aortic regurgitation vs 0.29 aortic regurgitation, P = .049), whereas the mean annual progression rate of aortic regurgitation was marginally higher in group Y (0.132 aortic regurgitation vs 0.075 aortic regurgitation, P = .1). Concomitant cusp intervention was associated with a significant aortic regurgitation increase in both groups (P < .0001). There was a trend that smaller preoperative aortic annulus diameters in group D and larger diameters in group Y were associated with increased aortic regurgitation over time.

Conclusion: In regard to aortic regurgitation grade over time, patients with Marfan syndrome and a large preoperative aortic annulus diameter were better treated with the reimplantation technique, whereas those with a smaller diameter were better treated with the remodeling technique. Concomitant free-edge plication of prolapsing cusps was disadvantageous in both groups. Considering these factors may serve to improve the aortic valve longevity after valve-sparing aortic root surgery.

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