Decade of aortic valve sparing reimplantation: are we pushing the limits too far?

BACKGROUND: This single center study assesses the outcome of aortic valve sparing reimplantation (AVS) in 284 consecutive patients who were operated on for various indications during the last 11 years.

METHODS AND RESULTS: From July, 1993, to July, 2004, 284 patients underwent AVS. Mean age was 53+/-16 (range 8 to 84) years. Of the 284 patients, 184 were male (64.8%) and 54 (19%) experienced Marfan's syndrome. Acute aortic dissection Stanford type A was present in 53 patients (19%) and a bicuspid aortic valve was present in 17 patients (6%). Concomitant arch replacement was necessary in 120 patients (42%). Additional procedures were performed in 66 patients (23.2%). Mean follow-up time was 41+/-32 (range 0 to 130) months. The 30-day mortality was 3.2% overall, 11.3% in emergency patients, and 1.3% in elective patients. Mean bypass time was 174+/-48 (range 90 to 440) minutes and aortic cross clamp time was 132+/-33 (range 64 to 283) minutes. In patients undergoing arch replacement, circulatory arrest was 25+/-17 (range 7 to 99) minutes. Rethoracotomy for bleeding was required in 4.6% of patients. During follow-up, there were 20 (7.3%) late deaths. Reoperation of the reconstructed valve was required in 15 patients (5.3%); underlying reasons were endocarditis (n=4) and aortic insufficiency (n=11) requiring aortic valve replacement. Average grade of aortic insufficiency increased significantly from 0.23+/-0.46 postoperatively to 0.34+/-0.59 at latest evaluation (P=0.026). Two patients experienced a transient ischemic attack early postoperatively; no further thromboembolic complications were noticed. The majority of patients (96%) presented with a favorable exercise tolerance at last contact.

CONCLUSIONS: The aortic valve reimplantation technique leads to excellent clinical outcome in patients with various pathologies. Lack of anticoagulation and favorable durability should encourage the extension of indications for this technique.