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DOI: 10.1055/s-0029-1246656
Should root replacement with aortic valve-sparing be offered to patients with severe aortic regurgitation or bicuspid valves?
Objective: To examine the results of root replacement with aortic valve-sparing in patients with bicuspid aortic valve or severe aortic regurgitation (AR).
Methods: Between 2000–2009 one hundred two patients (mean age 47±17.5 years) underwent aortic valve-sparing procedures for ascending aortic aneurysm or dissection. Twenty-one (20.6%) presented with Marfan's syndrome. Patients were assigned to three different groups according to the aortic valve pathology: bicuspid aortic valve (BAV) (n=11), tricuspid aortic valve (TAV) with AR< severe (n=51), and TAV with severe AR (n=40). Remodeling of the aortic root was performed in 28 (27.5%) patients, reimplantation of the aortic valve in 74 (72.5%) and a concomitant cusp repair in 30 (29.4%). All patients were prospectively studied with annual clinical assessment and echocardiography.
Results: Overall actuarial five years survival was 97.8±1.5% without differences between the groups. Actuarial five years freedom from aortic valve reoperation was 92.2±3.2% in all patients, 100% in patients with a BAV, 98±1.9% in patients with a TAV and AR< severe, and 82.7±7.5% in patients with a TAV and severe AR (p=0.07). Among patients who required reoperation for recurrent AR, 3/6 (50%) presented with Marfan's syndrome.
Conclusions: The outcome in terms of survival is excellent for all patients after aortic valve-sparing operations. There is no difference in terms of reoperation between patients who presented with BAV or TAV. Reoperation rates are higher for patients who presented with severe AR but do not reach statistical significance. Hence, root replacement with aortic valve-sparing should be offered even in presence of a bicuspid aortic valve or severe AR.