Abstract 3709: Aortic Root Remodeling Leads to Durable Restoration of Aortic Valve Function: 10-Year Experience with 262 Patients
Dilatation of the aortic root with concomitant aortic regurgitation can be treated by valve-preserving surgery. We have chosen root remodeling rather than reimplantation whenever the aorto-ventricular junction was not dilated. We have analysed our 10-year experience with root remodeling. Between 10/1995 and 4/2006, 262 patients (190 male; 72 female, age 60±15 years) were treated by root remodeling in the presence of a normal aorto-ventricular diameter (< 30 mm). Acute aortic dissection was present in 43 patients. Valve anatomy was tricuspid in 182, and bicuspid in 80 patients. Cusp pathology was additionally corrected in 158 patients (60.3 %). Follow-up was complete in 99%. Cumulative follow-up was 971 patient -years with a mean of 3.9±2.6years. Hospital mortality was 3.8% (10/262; elective surgery: 3.2%; emergency surgery: 7%). One patient developed endocarditis 2 months postoperatively and underwent valve replacement. Neurologic complications were observed in 3 patients after emergency surgery (paraparesis: n=2, cerebral infarction: n=1). Another patient suffered a PRIND after elective surgery. Freedom from AI ≥ II was 91% at 5 years and 90% at 10 years. Eight patients required reoperation, in 5 patients the valve was replaced, in 3 patients re-repaired. Freedom from reoperation was 96% at 5 and 10 years. Freedom from valve replacement was 98% at 5 and 10 years. A comparison of 3 operative periods (95–98; 99 – 02; 03– 06) showed that with increasing experience cusp prolapse was diagnosed and corrected more frequently (8/49=17%; 62/105= 59%; 88/108=82%; p<0.0001), while valve stability significantly improved over time (freedom from AI ≥II; p=0.007). Root remodeling leads to durable restoration of aortic valve function. Aggressive search for and correction of cusp prolapse does not have an adverse but rather beneficial effect on aortic valve competence.