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(Circulation. 2009;120:S120-S126.)
© 2009 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Effects of Preoperative Aortic Insufficiency on Outcome After Aortic Valve–Sparing Surgery

Laurent de Kerchove, MD; Munir Boodhwani, MD, MMSC; David Glineur, MD; Alain Poncelet, MD; Robert Verhelst, MD; Parla Astarci, MD; Valérie Lacroix, MD; Jean Rubay, MD, PhD; Michel Vandyck, MD; Jean-Louis Vanoverschelde, MD, PhD; Philippe Noirhomme, MD; Gebrine El Khoury, MD

From the Divisions of Cardiothoracic and Vascular Surgery (L.d.K., M.B., D.G., A.P., R.V., P.A., V.L., J.R., P.H., G.E.L.), Anesthesiology (M.V.), and Cardiology (J.-L.V.), Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium.

Correspondence to Laurent de Kerchove, Division of Cardiothoracic and Vascular Surgery, Cliniques Universitaires St-Luc, Ave Hippocrate 10, 1200 Brussels, Belgium. E-mail laurent.dekerchove{at}uclouvain.be

Background— The presence of significant preoperative aortic insufficiency (AI) or the need for cusp repair has been suggested as a risk factor for poorer outcomes after aortic valve (AV)–sparing surgery. We analyzed the influence of these factors on the mid-term outcomes of AV surgery.

Methods and Results— Between 1996 and 2008, 164 consecutive patients underwent elective AV-sparing surgery. Severe preoperative AI (grade 3+) was present in 93 patients (57%), and 54 (33%) had a bicuspid valve. Root repair was performed with either the reimplantation (74%) or the remodeling (26%) technique, and cusp repair was performed in 90 patients (55%). Mean clinical follow-up was 57 months. Hospital mortality was 0.6%. Cusp repair was required in 52% of the patients with preoperative AI 2+ and in 57% of those with AI 3+ (P=0.6). Cusp repair was required more frequently in bicuspid versus tricuspid valves (91% versus 38%, P<0.001). Overall survival at 8 years was 88±8%. Freedom from AV reoperation at 8 years was similar with preoperative AI 2+ versus preoperative AI 3+ (89±11% versus 90±7%, P=0.7) and with versus without cusp repair (84±17% versus 92±8%, P=0.5). Freedom from recurrent AI (grade 3+) at 5 years was also similar between groups (90±10% versus 89±8%, P=0.9, and 90±8% versus 89±9%, P=0.8, respectively). By multivariate analyses, predictors of recurrent AI 2+ were preoperative left ventricle end-diastolic diameter and AI >1+ on discharge echocardiography.

Conclusions— With a systematic approach to cusp assessment and repair, AV-sparing surgery for root pathology has an acceptable mid-term outcome, irrespective of preoperative AI or need for cusp repair.

Key Words: aortic valve–sparing surgery • aortic insufficiency • aortic valve repair • aortic root aneurysm