Ascending aortic replacement with aortic valve reimplantation

Background-Reimplantation of the native, structurally intact aortic valve w ithin a Dacron tube graft in patients with aortic root aneurysms corrects a nnular ectasia and dilatation of the sinotubular junction. The durability o f this valve repair with respect to the increased mechanical stress on valv e cusps has been discussed, is quite contrsversial, and is vet unknown. Methods and Results-From July 1993 to November 1998, a replacement of the a scending aorta with a repair of the aortic valve was performed in 75 patien ts (53 men and 22 women aged 50+/-19 years). Twenty-one patients (28%) had Marfan syndrome, and 11 patients (15%) had an aortic dissection, type Stanf ord A (6 acute. 5 chronic). Tn 17 patients (23%), concomitant replacement o f the aortic arch was necessary. Clinical and echocardiographic follow-up w as performed in 6- to 12-month intervals for a cumulative study period of 1 37 patient-years. No operative deaths occurred. Two patients (3%) died 5 an d 20 months postoperatively. One additional patient experienced a transient isr hemic attack within the first postoperative week. Three patients (4%) with progressive aortic insufficiency required aortic valve replacement aft er 9, 11, and 14 months. All other patients had no or mild aortic insuffici ency. The repairs have now remained stable for less than or equal to 65 mon ths (mean, 22+/-20 months). Other valve-related complications did not occur . Conclusions Our results demonstrate that this type of aortic valve repair a chieves excellent results in selected patients. Perfect coaptation of valve cusps during the repair with no or only trace aortic insufficiency at init ial echocardiography seems to be essential for durability.