Preservation of the native aortic valve in the treatment of aortic root aneurysmal dilatation.

Mechanical valve conduit replacement of the aortic root is a durable and ap propriate procedure for aortic root dilatation with or without aortic aorti c insufficiency. But this procedure may sacrifice an anatomically salvageab le aortic valve and requires a life-long anticoagulation with its attendant thromboembolic versus haemorrhagic risks, which is not ideal for young act ive patients. Recently, two techniques of aortic root replacement with aort ic valve sparing have been described, based on experimental data. The first one is Yacoub's procedure (1983), where the correction of the aor tic root is performed by correcting the sinotubular junction and replacemen t of the aortic sinuses with an appropriately tailored Dacron graft (remode lling). The second technique was described by David (1992). In this one, th e aortic root reconstruction is performed by reimplanting the aortic valve in a tubular Dacron graft (reimplantation). Since 1993, we have been intere sted in these procedures and the aim of this study was to examine the perio perative and intermediate term results of these techniques. From 1993 to 1998, 14 patients had either reimplantation of the aortic valv e (3 patients) or remodelling of the aortic root (11 patients). Patients' a ges ranged from 17 to 57 years (40.2 +/- 7.9 years). Four patients had Marf an's syndrome (29%), There were 11 cases of aortic insufficiency, three 1(21.4%), 3+ (21,4%), seven 2+ (50%) and one 3+ (7.2%). All the patients had morphologically normal aortic leaflets. The mean diameter of the sinuses w as 57 +/- 4 mm. There was no acute or chronic dissection. The left ventricu lar function was measured as the percentage of the fractional shortening of the left ventricular diameter. The mean of the fractional shortening was 3 8.3 +/- 4%. There was no mortality and all patients underwent early and late follow-up echocardiography. The 14 patients have only mild or no insufficiency, which has not progressed in any patient. No other valve-related complication has occurred. Aortic valve-sparing replacement of the aortic root is an excell ent procedure for patients with aortic root dilatation and anatomically sal vageable valves. The long-term results are still unknown but it seems an at tractive alternative to composite replacement of the aortic valve and desce nding aorta. Morbidity and mortality rates are very low, even lower than a Bentall procedure, while the savings in cost and human lives due to the abs ence of a mechanical valve prosthesis are significant.