Valve-preserving replacement of the ascending aorta: Remodeling versus reimplantation

Objective: Aortic valve regurgitation in combination with dilatation of the ascending aorta and root requires a combined procedure to restore valve fu nction and eliminate pathologic dilatation of the proximal aorta. Two techn iques have been proposed for this purpose; the aortic root may be either re modeled with an especially configured vascular graft or replaced with reimp lantation of the aortic valve within the graft. We have used both technique s depending on the individual pathologic condition of the aortic root. Meth ods: Of 107 patients undergoing operation for proximal aortic disease betwe en October 1995 and November 1997, 40 patients had morphologically intact a ortic valve leaflets in conjunction with dilatation of the aortic root. Of these, 15 patients underwent an operation as a surgical emergency for acute aortic dissection type A. In 29 instances, root remodeling in conjunction with ascending aortic replacement was performed; 11 patients underwent radi cal replacement of the proximal aorta with reimplantation of the aortic val ve, Partial or total arch replacement was performed additionally in 27 of t hese patients. Other concomitant procedures were coronary artery bypass gra fts (n = 11) and mitral reconstruction (n = 1), Results: Two patients died after repair of acute aortic dissection, for a total operative mortality ra te of 5%. No patient died after elective surgery. Aortic valve function cou ld be effectively restored with both techniques. No patient underwent reope ration on the proximal aorta: freedom from aortic regurgitation of grade II or more at 1 year is 88% with both techniques, Conclusions: Depending on i ndividual root pathologic condition, both the remodeling and the reimplanta tion techniques appeared to have their individual merits. Both result in ad equate restoration of aortic valve function and elimination of pathologic a ortic dilatation.