Aortic valve resuspension in ascending aortic aneurysm repair with aortic insufficiency.

BACKGROUND

The known complications of prosthetic valve replacement in patients with an ascending aortic aneurysm and secondary aortic regurgitation who frequently have a morphologically normal aortic valve have prompted interest in valve-sparing aneurysm repair procedures. The aim of this study was to define the echocardiographic criteria for identifying suitable candidates for ascending aortic aneurysm repair that spares the aortic valve. We also examined the perioperative and intermediate-term results of this innovative procedure.

METHODS

Fifteen patients underwent ascending aortic replacement with resuspension of the native valve within a vascular prosthesis and reimplantation of the coronary ostia. Echocardiography was performed preoperatively and intraoperatively, before discharge, and during follow-up. Thirteen patients had nondissecting aneurysms, and 2 patients had a Standford type A aortic dissection. The mean age of the patients was 48 +/- 18 years. Only patients with morphologically normal aortic leaflets and leaflets of similar size were selected.

RESULTS

There was one death perioperatively, and this was due to sepsis. The procedure failed in 1 patient, and a valved conduit was implanted during the same operation. In the 13 others the aortic annulus diameter was significantly reduced from 27.1 +/- 2.2 mm preoperatively to 22.2 +/- 1.9 mm postoperatively (p < 0.05). The severity of aortic insufficiency decreased from 2.9 +/- 0.7 to 0.6 +/- 0.4 (p < 0.05). The peak aortic gradient increased from 11.5 +/- 6.5 to 20.3 +/- 16 mm Hg. A slight increase in the aortic annulus diameter to 24.3 +/- 1.0 mm and normalization of the peak aortic gradient to 9.8 +/- 7.8 mm Hg were noted at follow-up. There was no significant increase in aortic insufficiency.

CONCLUSIONS

In selected patients undergoing ascending aortic aneurysm repair who have normal aortic leaflets but secondary aortic regurgitation, the native valve can be spared through this novel operation. The aortic annulus size is reduced significantly, thereby effectively eliminating hemodynamically significant aortic regurgitation. The intermediate-term results are promising, but the long-term durability of this type of repair needs to be determined.