Replacement of ascending aorta with aortic valve reimplantation: midterm results

Objective. Aneurysms of the aortic root lead to aortic valve incompetence d ue to dilatation of the sinotubular junction and annuloaortic ectasia. Reim plantation of the native, structurally intact aortic valve within a Dacron tube graft corrects annular ectasia as well as dilatation of sinotubular ju nction and aortic sinuses. Durability of this valve repair with respect to increased mechanical stress on valve cusps is discussed controversially and is yet unknown. Methods: Since 7/93, replacement of the ascending aorta wi th repair of the aortic valve was performed in 48 patients (34 male, 14 fem ale; 47 +/- 20 years) with aortic insufficiency and aneurysm of the aortic root, Fifteen patients (31%) had Marfan's syndrome and five patients (10%) had an aortic dissection type A (two acute, three chronic). In 11 patients (23%), concomitant replacement of the aortic arch was necessary utilizing e lephant trunk technique in two patients. Additionally, one patient required mitral valve repair and two other patients coronary artery bypass grafts. Clinical and echocardiographic follow-up was performed in 6-12 month interv als for a cumulative study period of 100 patient years. Results: There were no operative deaths. Two patients (4%) died 5 and 20 months post operative ly. One additional patient experienced a TIA within the first postoperative week. Three patients (6%) with an early postoperative aortic insufficiency (AI) > 1 required aortic valve replacement after 9, 11, and 14 months due to progressive AI. In these patients, distortion of the aortic root geometr y led to valve incompetence. All other patients have no or mild aortic insu fficiency. The repair now remains stable for up to 63 months (mean 25 +/- 1 8 months). Other valve related complications did nor occur. Conclusions: Ou r results demonstrate that this type of aortic valve repair achieves excell ent results in selected patients. Perfect coaptation of valve cusps during the repair with no or only trace AI at initial echocardiography seems to be essential for durability. (C) 1999 Elsevier Science B.V. All rights reserv ed.