[Aortic valve insufficiency in aneurysms of the ascending aorta: functional results following valve-sparing reconstruction].

BACKGROUND AND OBJECTIVE: Changes in geometry of the aortic root, especially a dilatation of the sinotubular junction, are the major causes of aortic valve regurgitation in ascending aortic aneurysm. In valves without structural defect, a valve sparing aortic root reconstruction may be a therapeutic option. Aim of this study was the assessment of functional results, in the early postoperative, and during follow-up, in a large patient cohort from one centre. PATIENTS AND METHODS: Between July 1993 and March 1998, a total of 48 valve sparing operations were performed at Hannover Medical School. Mean age of patients (34 males, 14 females) was 47.4 +/- 19 years. In a prospective design clinical, and echocardiographic examinations were performed pre-, intra and early postoperatively as well as 3.6 and then every 12 months during follow-up. Structural valve changes, systolic pressure gradients as well as the degree of diastolic regurgitation were evaluated. RESULTS: Aortic root reconstruction was successful in all patients; none died perioperatively. Extension of the underlying disease to the aortic arch was present in eleven, acute and chronic dissection of the ascending aorta (type A) in two and three patients, respectively. Echocardiographic follow-up over a mean period of 25.1 +/- 18.3 months (cumulatively 1204 months) revealed stable valve function in 41 patients without (n = 30) or with a minimal (n = 11) regurgitation. In three patients moderate valve regurgitation (grade 2) was observed, three patients (6.3%) had to be reoperated because of a progressive valve failure. Thromboembolic or bleeding complications were not observed. CONCLUSIONS: Valve sparing aortic root reconstruction is a promising alternative to the composite replacement of the ascending aorta. Low perioperative morbidity and mortality rates as well as favourable functional results were demonstrated. Long-term anticoagulation can be avoided. Long-term follow-up will be necessary to assess the definitive role of this new surgical approach.