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Valve-sparing aortic root remodeling with partial preservation of the intact native aortic sinuses

Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany

Received 24 February 2009; received in revised form 24 May 2009; accepted 27 May 2009.

^_* Corresponding author. Address: Clinic of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany. Tel.: +49 451 5002108; fax: +49 451 5002051. (Email: h.sievers{at}herzchirurgie-luebeck.de).

There are certain aortic root pathologies where only one or two of the aortic sinuses are diseased. We aimed to evaluate our mid-term results after a partial remodeling of the aortic root. A total of 220 patients underwent a valve-sparing operation at our institution. In 29 patients (mean age: 62 ± 10 years), two (n = 22) or one (n = 7) native aortic sinuses were preserved. Operative indication was type A aortic dissection (n = 12) or aortic root aneurysm (n = 17). Preoperative aortic valve regurgitation was 1.8 ± 1.1 grades. Mean follow-up time was 46 ± 32 months. At the latest follow-up, 23 patients were alive and asymptomatic. One ascending aorta re-operation was observed due to late aortic graft infection. Echocardiographic measurements at latest follow-up were excellent: aortic regurgitation: 0.6 ± 0.5 grades; aortic valve area: 2.7 ± 0.7 cm²; aortic root dimensions: anulus 23 ± 3 mm, sinus 34 ± 5 mm, sinotubular junction 28 ± 5 mm and ascending aorta: 30 ± 2 mm. Longitudinal analysis revealed no development of clinically significant aortic regurgitation (<0.03 grades per year). However, in contrast to the group that underwent complete remodeling (n = 108), a significant dilatation at sinus and ST junction (STJ) level could be observed in the partial remodeling group over time (0.35 and 0.48 mm per year, respectively). This should be taken into consideration when applying this technique in patients operated on an elective basis.

Key Words: Aortic root • Aortic valve repair • Heart valve • Valve disease