Does preoperative degree of aortic insufficiency influence early and midterm results of sparing surgery?

OBJECTIVE

Aortic valve-sparing operations have shown excellent results in patients with aortic root and or ascending aorta aneurysm. Aortic valve regurgitation is frequently detected in these patients as a result of significant dilation of the aortic root.The aim of this study was to assess the impact of preoperative aortic incompetence degree on the early and midterm outcomes of sparing surgery.

METHODS

From September 2001 to July 2006, 84 patients with aortic root aneurysm underwent aortic valve-sparing surgery according to the reimplantation technique. Depending on preoperative grade of aortic insufficiency (AI), two groups were identified: 31 patients (study group, SG) with AI grade III-IV and 53 (control group, CG) with AI grade II or less. The Gelweave Valsalva prosthesis was used in 76 patients (90.5%). Intraoperative, perioperative variables and outcomes at follow-up were retrospectively compared between the groups.

RESULTS

Patient demographics and types of operations were comparable between groups. Early mortality rates were almost identical in both groups (3.2% SG vs. 5.7% CG; P = 0.961); at follow-up (FU), no patient died in both groups. Grade III-IV AI was similar in both groups early postoperatively (6.4% SG vs. 3.8% CG; P = 0.981) and during follow-up (13.3% vs. 8%; P = 0.755). Reoperaton rate for AI was 3.3% in SG vs. 6% in CG (P = 0.980).

CONCLUSIONS

Preoperative degree of aortic regurgitation does not impair the outcomes of the valve-sparing operation which seem to depend on more factors. Early results were affected by the learning curve but midterm outcomes showed a progressive improvement. Patients with satisfactory reconstruction show stable results over time.