Functional results after aortic valve repair in aortic root ectasia.

BACKGROUND AND AIMS OF THE STUDY

Aortic insufficiency due to dilation of the aortic root is a common finding. Although combined replacement of the aortic valve and the ascending aorta is regarded as standard treatment, total replacement of the proximal aorta with a tube graft and resuspension of the valve is a new alternative.

METHODS

Between June 1993 and June 1995, 23 patients underwent this type of aortic repair. Seven patients exhibited the typical features of Marfan's syndrome. Echocardiography was performed pre- and intraoperatively as well as three, six and then every 12 months postoperatively for a cumulative follow up period of 355 months (5-30; mean 15.9 +/- 7.9 months).

RESULTS

The pre-existing aortic valve insufficiency (grade II-IV, mean 2.9) was reduced postoperatively to grade 0-1 (mean 0.3). The NYHA functional class improved from a mean of 2.8 to 1.8. During the follow up period 20 patients showed a stable valve function with either no (n = 13), or a mild valve regurgitation (n = 7). Two patients had to be reoperated for progressive aortic insufficiency 11 and 14 months after repair, undergoing valve replacement. A third patient required reoperation because of relapsing endocarditis.

CONCLUSION

It is concluded that in patients with aortic valve insufficiency due to dilation of the proximal aorta, valve sparing reconstruction is a promising approach. Without the need for anticoagulation, good functional results could be demonstrated. Further follow up is required to assess the long term function of this kind of aortic valve repair.