Guglielmo Stefanelli1,3, Fabrizio Pirro1, Alina Olaru1, Vincenzo Smorto1, Massimo Longo1, Luca Weltert21Department of Cardiology and Cardiac Surgery, Hesperia Hospital, Modena, Italy
2Department of Cardiac Surgery, European Hospital, Rome, Italy
3Electronic correspondence: firstname.lastname@example.org
Background and aim of the study: The study aim was to evaluate long-term results after reimplantation surgery using a straight tubular prosthesis to treat patients affected by aortic root aneurysm with or without aortic valve insufficiency (AI).
Methods: A cohort of 52 consecutive patients (mean age at repair 59 ± 8.7 years; range: 32 to 75 years) underwent aortic valve-sparing surgery between 2004 and 2016. Preoperative moderate to severe AI was present in 30 patients (57%). The aortic valve was bicuspid in six patients (11.5%). Four patients (7.7%) had undergone previous cardiac surgery, and nine (17.3%) received an associated procedure. All operations consisted of a reimplantation procedure (David 1). Cusp repair was associated in 26.9% of cases. The mean follow up period was 78 ± 41 months (range: 2 to 143 months), and was 100% complete. Primary end points of the analysis included early and late mortality, absence of recurrent AI grade <2+, and an absence of valve-related reoperation.Results: There was no early/in-hospital mortality. Two patients died during the follow up period, one from
cardiac-related causes. The overall survival rate was 98.1% at five years, and 95.4% at 10 and 12 years. Freedom from greater than mild AI was 100% at discharge, 100% after five years follow up, and 88.6% at 10 and 12 years follow up. Two patients developed moderate to severe AI during the follow up and both underwent reoperation, at respectively eight and nine years after reimplantation. Overall freedom from reoperation due to valve malfunction was 100% at five years, and 88.6% at 10 and 12 years.
Conclusion: Aortic valve-sparing surgery via the reimplantation technique provides excellent long-term results. Although significant risk factors for poor results were not identified, it is believed that in order to obtain satisfactory outcomes, preoperative evaluation of the root geometry, precise sizing of the aortic root prosthesis, degree of postoperative residual AI, and correct cusp configuration at transesophageal echocardiography remain primary determinants, rather than the type of aortic prosthesis.
The Journal of Heart Valve Disease 2018-19;28:35-43
|Long-Term Follow Up After Reimplantation Surgery Using a Straight Tube|
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