Late Outcomes After Aortic Valve Repair

Background: Aortic valve sparing surgery (AVSS) is an alternative to aortic valve replacement (AVR) in patients with aortic regurgitation. The decision to perform AVSS is based on the given data of each individual patient, with one emphasis being on the valves anatomy, particularly the valve cusps.
There are various procedures that can be done; Root replacement by re-implantation or the remodeling techniques, replacement of the ascending aorta at the level of the sinotubular junction (STJ), with the proper diameter Dacron graft and aortic cusp repair with or without replacing the aortic root. We report late outcomes of 191 cases undergoing various types of AVSS.

Methods: From February 2004, 191 patients with aortic regurgitation underwent AV repair or preserving surgery. 58 patients (30%) underwent David 1 procedure, 18 patients (9%) underwent David 2 procedure (Yacoub procedure), 68 patients (36%) underwent ascending aorta replacement at the height of the sinotubular junction (STJ), and 47 patients (25%) underwent cusp repair (eg. annuloplasty, resection, plication) without replacement of the aorta. Mean patient age was 46±18. 148 patients were males (77%).

Results: There were 2 cases (1%) of in-hospital mortality. Mean ICU time and mean ventilation time were: 39±55 hours and 14±25 hours, respectively. Mean hospital stay was 6±6 days. Follow-up time ranged between 1-132 months, with a mean of 31±29 months, and an overall 566 years of patient follow-up.
There were 11 cases (6%) of late death (from unknown cause). Freedom from reoperation due to recurrent AR or AS was 92%. Late echocardiography revealed that 162 patients (85%) had trivial or mild AR, 20(11%) moderate AR and 7(4%) had severe AR. At the last follow-up, 171 patients (91%) were NYHA class l or ll.

Conclusions: Our results show that the various AVSS procedures are relatively safe with and durable in most cases.