REPAIR OF THE AORTIC-VALVE IN PATIENTS WITH AORTIC-INSUFFICIENCY AND AORTIC ROOT ANEURYSM

Patients with aneurysms of the ascending aorta or aortic root frequent ly have aortic insufficiency despite normal aortic leaflets. The aorti c valve dysfunction is caused by dilatation of the sinotubular junctio n, distortion or dilatation of the sinuses of Valsalva, annuloaortic e ctasia, or a combination of these problems. In the case of annuloaorti c ectasia, reconstruction of the aortic root is performed by reimplant ing the aortic valve in a tubular Dacron graft (reimplantation). In th e case of mild or no annuloaortic ectasia, reconstruction of the aorti c root is performed by correcting the dilated sinotubular junction and replacement of the aortic sinuses if they are also dilated with an ap propriately tailored Dacron graft (remodeling). From July 1989 to Marc h 1994, 45 patients have had either reimplantation of the aortic valve (19 patients) or remodeling of the aortic root (26 patients). Fourtee n patients had Marfan's syndrome, 11 had acute and five had chronic ty pe A aortic dissection, and nine also had transverse arch aneurysm. Th ere were two operative deaths, both in the remodeling group. One patie nt who had reimplantation needed composite replacement of the aortic v alve and ascending aorta because of persistent aortic insufficiency af ter the repair. A young patient with Marfan's syndrome had progressive aortic valve dysfunction during a growth spurt and had aortic valve r eplacement 2 years after the initial operation. No other valve-related complication has occurred. The remaining 41 patients have only mild o r no aortic insufficiency, and the repair remains stable from 1 to 58 months, mean 18 months. These two types of aortic valve reconstruction have provided excellent clinical results in carefully selected adult patients.