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Mid-term Results of Aortic Root Reimplantation in Patients with Severe Aortic Regurgitation
Shunsuke Miyahara, Katsuhiro Yamanaka, Toshihito Sakamoto, Yoshikatsu Nomura, Takeshi Inoue, Masamichi Matsumori, Kenji Okada, Yutaka Okita.
Kobe University Graduate School of Medicine, Kobe, Japan.

OBJECTIVE:The aim of this study is to investigate the results of the valve-sparing root replacement with reimplantation technique in patients with severe aortic regurgitation (AR).
METHODS:From 2000 to 2013, 182 consecutive patients undergoing aortic root replacements were retrospectively reviewed. Clinical features and mid-term results of 88 (48.4%) patients with preoperative severe AR (group S) were compared with those of less than severe AR (group C). More cusp prolapse (64.8 % in group S and 22.3 % in group C, p<0.0001) and congenital bicuspid valve (31.8 % in group S and 8.5 % in group C, p<0.0001) was included in group S. Less Marfan syndrome was included in group S (12.9 % in group S and 35.9 % in group C, p=0.0003). Patients in group S had deteriorated LV function; LVEF of group S and group C was 54.2±10.4 % and 60.8±9.2 % (p= 0.0001), and LVDd of group S and group C was 62.9±10.0 mm and 52.1±8.1 mm (p<0.0001), respectively. Diameter of aorto-ventricular junction in group S was larger (26.6±3.8 mm in group S and 25.3±2.3 mm in group C, p=0.0086), but no significant difference was found in diameter of Valsalva sinus between groups (p=0.74).
RESULTS: Concomitant cusp repair was more frequently needed in group S (76.1% in group S and 45.7% in group C, p<0.0001). The overall survival at 5 and 10 years was 96.7±1.5 % and 91.0±5.7 %, respectively, including 3 in-hospital deaths (1.6%). Fourteen patients required reoperative aortic valve replacement or full root replacement: 11 for recurrent AR and 3 for endocarditis or graft infection. Freedom from reoperation at 5 year of group S and group C was 93.6±2.8 % and 92.2±3.5 %, respectively (p=0.36). Freedom from moderate AR or greater at 5 year was 79.7±5.9 % in group S and 89.0±3.8 % in group C, respectively (p=0.19).
CONCLUSIONS: Mid-term results of DVS root replacement performed in patients having severe AR preoperatively were satisfactory and comparable with those of moderate AR or less, despite complex cusp pathology and needs for concomitant cusp repair.

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