AORTIC-VALVE RESUSPENSION IN ASCENDING AORTIC-ANEURYSM REPAIR WITH AORTIC-INSUFFICIENCY

Background. The known complications of prosthetic valve replacement in patients with an ascending aortic aneurysm and secondary aortic regur gitation who frequently have a morphologically normal aortic valve hav e prompted interest in valve-sparing aneurysm repair procedures. The a im of this study was to define the echocardiographic criteria for iden tifying suitable candidates for ascending aortic aneurysm repair that spares the aortic valve. We also examined the perioperative and interm ediate-term results of this innovative procedure. Methods. Fifteen pat ients underwent ascending aortic replacement with resuspension of the native valve within a vascular prosthesis and reimplantation of the co ronary ostia. Echocardiography was performed preoperatively and intrao peratively, before discharge, and during follow-up.-Thirteen patients had nondissecting aneurysms, and 2 patients had a Stanford type A aort ic dissection. The mean age of the patients was 48 +/- 18 years. Only patients with morphologically normal aortic leaflets and leaflets of s imilar size were selected. Results. There was one death perioperativel y, and this was due to sepsis. The procedure failed in 1 patient, and a valved conduit was implanted during the same operation. In the 13 ot hers the aortic annulus diameter was significantly reduced from 27.1 /- 2.2 mm preoperatively to 22.2 +/- 1.9 mm postoperatively (p < 0.05) . The severity of aortic insufficiency decreased from 2.9 +/- 0.7 to 0 .6 +/- 0.4 (p < 0.05). The peak aortic gradient increased from 11.5 +/ - 6.5 to 20.3 +/- 16 mm Hg. A slight increase in the aortic annulus di ameter to 24.3 +/- 1.0 mm and normalization of the peak aortic gradien t to 9.8 +/- 7.8 mm Hg were noted at follow-up. There was no significa nt increase in aortic insufficiency. Conclusions. In selected patients undergoing ascending aortic aneurysm repair who have normal aortic le aflets but secondary aortic regurgitation, the native valve can be spa red through this novel operation. The aortic annulus size is reduced s ignificantly, thereby effectively eliminating hemodynamically signific ant aortic regurgitation. The intermediate-term results are promising, but the long-term durability of this type of repair needs to be deter mined.