Abstract 3710: Up to 13 Years Clinical and Echocardiographic Follow-up after Different Aortic Valve Sparing Operations
Background: Currently used standard techniques in aortic root preserving procedures are performed in the David- (reimplantation technique) and Yacoub- operation (remodeling technique). For final judgement of these techniques as an alternative to the use of valve conduits long term follow-up of patients undergoing these procedures are required.
Methods and Results: From July 1993 to July 2005, 68 consecutive patients (41%) underwent the David-operation (D) and 96 patients (59%) the Yacoub-operation (Y). Mean age was 50+/−16 years in group D (73% male) and 56+/−15 years in group Y (63% male); p=n.s. Underlying diseases were acute type A aortic dissection (n=56), aneurysm ≥ 4.5cm (n=130), and Marfan‘s syndrome (n=30); respectively. Completeness of follow-up was 100%. Mean clinical follow-up was 4.0+/−2.9 years, range 0.1 to 12.7 years. Probability of overall survival in group D at 12.7 years was 80.0+/−8.0% and in group Y at 9.4 years 80.0+/−5.0%. Indication for valve related re-operation was aortic regurgitation (AR) in eight patients (n=1 in group D and n=7 in group Y; p=n.s.). Of these, 3 patients had acute type A aortic dissections and use of glutaraldehyde (GFR) glue for aortic root reconstruction. Freedom from aortic valve related re-operation was 97.8+/−4.3% in group D and 88.7+/−8.5% in group Y (p=n.s.). Mean pressure gradient of the left ventricular outflow tract was 5.4+/−4.7mmHg (D: 6.0+/−4.8mmHg; Y: 5.0+/−4.7mmHg); p=n.s. Overall grade of AR was: AR grade I: 24%, AR grade II: 3.0%, AR grade III: 4.3% (D: 17.6%, 2.9%, 1.5%, and Y: 28.4%, 3.2%, and 6.3%, respectively).
Conclusions. Aortic valve sparing operations offer excellent long-term valve performance and survival. The slightly higher rate of valve related re-operations in the remodeling technique may be related to technical details and the use of GFR glue in earlier years.