Aortic Valve Sparing Surgery as Alternative in Aortic Root Disease. Long-term Outcomes

espanolIntroduccion: Desde 1968, la enfermedad aneurismatica de la raiz aortica ha sido tratada mediante el remplazo con tubo valvulado.En las ultimas decadas la cirugia de preservacion valvular surgio y evoluciono como una opcion al remplazo protesico.Objetivo: Reportar la experiencia institucional en la tecnica de preservacion valvular y sus resultados a largo plazo.Material y metodos: Revision de 116 casos consecutivos con criterios de reparabilidad, intervenidos entre 2005 y 2019. Previoecocardiograma transesofagico (ETE) y angiotomografia (AngioTC), se procedio quirurgicamente acorde a la clasificacionanatomofuncional, con la combinacion de tecnicas. Se realizo control intraoperatorio y conversion a remplazo segun el criteriodel cirujano interviniente. Se reportan las variables intraoperatorias, la morbimortalidad intrahospitalaria y la mortalidad,la libertad de insuficiencia valvular significativa y la reoperacion en el seguimiento clinico y ecocardiografico.Resultados: La edad media era 56 ± 15,6 anos, varones 73%, 59% asintomaticos, intervenidos por diametro aortico (52 ± 11,7mm) o progresion de valvulopatia. En el posprocedimiento, 4% de los casos resulto con insuficiencia leve o nula y 2 conversiones(1,7%); mortalidad hospitalaria 0,9%. A 10 anos de seguimiento, sobrevida actuarial del 88% y libertad de insuficienciasignificativa (moderada/grave) 79%. Se reintervinieron 5 casos, a un intervalo promedio de 9,1 anos, libertad de reoperacionde 90% a 10 anos. No se registraron eventos tromboembolicos ni hemorragicos mayores.Conclusion: las tecnicas de preservacion valvular aortica, en contexto de enfermedad de la raiz, resultan una opcion factible,segura y estable en el tiempo. EnglishBackground: Since 1968, ascending aorta replacement with a valved conduit has been the standard practice for aortic root aneurysm.By the end of the 20th century, aortic valve sparing operation emerged and evolved as an alternative to aortic valve replacement.Objective: The aim of this study was to report our experience with aortic valve sparing technique and its long -term outcomes.Methods: A total of 116 consecutive cases with criteria of repairability operated on between 2005 and 2019 were analyzed. Preoperativetransesophageal echocardiography (TEE) and computed tomography angiography (CTA) were used in combination to determinethe aortic phenotype based on a previous anatomical and functional classification. Perioperative control was performed and conversionto aortic valve replacement was left to the discretion of the attending surgeon. Intraoperative variables, in-hospital morbidityand mortality, freedom from significant aortic regurgitation (AR) and reoperation in the clinical and echocardiographic follow-upwere reported.Results: Mean age was 56±15.6 years and 73% were men; 59% were asymptomatic, and the reason for the intervention was theaortic diameter (52±11.7 mm) or progression of AR. After the procedure, 4% of the cases presented mild or trivial AR and 2 patientsrequired conversion to aortic valve replacement (1.7%). In hospital mortality was 0.9%. Actuarial survival was 88% at 10 years, and79% were free from significant (moderate/severe) AR. Five cases underwent reoperation after a mean interval of 9.1 years and freedomfrom reoperation at 10 years was 90%. There were no major thromboembolic or bleeding events.Conclusion: Aortic valve sparing technique in the setting of aortic root disease is a feasible and safe option, and stable over time.