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Root remodeling does lead to stable long-term aortic valve function
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DOI：10.1016/j.circv.2024.06.002.png)
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Abstract
En 中文
Background Root remodeling is one form of valve-preserving root replacement for aortic regurgitation and root aneurysm, which we have employed consistently for more than 28 years. Methods Between 10/95 and 7/2023 root remodeling was performed in 1285 patients (76% male, mean age 53 +/- 14 years). The aortic valve morphology was unicuspid in 34 (3%), bicuspid in 525 (41%) and tricuspid in 726 (56%) patients. Fifty-four patients (4%) had Marfan's syndrome. Measurement of valve configuration (effective height) was performed in 1075 (84%), and an external suture annuloplasty was added in 705 patients (55%). Cusp repair was performed in 1143 (89%) patients, most commonly for prolapse (n = 1000; 82%). Mean follow-up was 6.7 +/- 5.5 years (1 month to 28 years). Follow-up was 95% complete (8026 patient-years). Results Survival was 71% at 20 years, freedom from cardiac death 80%. Freedom from aortic regurgitation >= 2 was 77% at 15 years. Freedom from reoperation was 89%, higher in tricuspid (94%) compared to bicuspid (84%) and unicuspid valves (p < 0.001). With a suture annuloplasty, freedom from reoperation was 94% at 12 years. The difference with (94%) or without annuloplasty (91%) was not significant (p = 0.949). Conclusion Root remodeling is a viable option in valve-preserving root replacement. Concomitant cusp prolapse is frequent and can be corrected reproducibly by intraoperative measurement of effective height. The long-term stability of the aortic valve depends primarily on the underlying morphology. Up to 15 years postoperatively, the addition of an annuloplasty had a limited positive effect on residual regurgitation, but (as yet) no effect on freedom from reoperation.
Keywords:
Aortic root
Aortic root aneurysm
Valve-preserving root replacement
Aortic cusp repair
Aortic valve repair
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