Repair of ruptured sinus of Valsalva aneurysm: Determinants of long-term survival

Background. Ruptured sinus of Valsalva aneurysm is a rare cardiac anomaly a nd long-term survival after surgical treatment is not well established. Thi s study was designed to investigate the determinants of long-term survival after repair of ruptured sinus of Valsalva aneurysm. Methods. From April 1978 to April 1996, 53 patients underwent operation for ruptured sinus of Valsalva aneurysm. The incidence among our cardiac surgi cal population was 0.56%. Long-term survival was investigated in 46 patient s (13 to 65 years) who survived the operation, with 96.2% follow-up complet eness (mean +/- standard deviation, 6.5 +/- 4.9 years; maximum, 17.2 years) , by univariate and multivariate analyses. Results. There was no early operative death and no recurrence after the ini tial repair. Actuarial survival was 83.8% +/- 8.4% at 15 years. Reoperation , aneurysm draining into the left ventricle, aortic prosthetic dehiscence, bacterial endocarditis, and aortic cross-clamp time (<70 minutes) were sign ificant factors in long-term survival (p < 0.05). Multivariate analysis rev ealed that only aortic prosthesis dehiscence was the significant factor inf luencing late survival (p = 0.0001). Conclusions. Surgical treatment for ruptured sinus of Valsalva aneurysm is safe and has satisfactory results. Aortic prosthesis dehiscence is the inde pendent determinant for long-term survival. Other factors including bacteri al endocarditis, concomitant ventricular septal defect repair, and aortic v alve replacement did not independently influence long-term survival. (C) 19 98 by The Society of Thoracic Surgeons.