Reconstruction of the ascending aorta and aortic root: Experience in 45 consecutive patients

Background. Patients with aneurysms of the ascending aorta or aortic root m ay have associated aortic insufficiency (AI). We reviewed our experience wi th aortic root remodeling and reconstruction of the sine-tubular junction. Methods. Forty-five patients were operated on between July 1995 and Septemb er 1998. Transesophageal echocardiography showed AI grade III or IV in 15 p atients. Twenty-seven patients had replacement of all three sinuses, 10 of one or two sinuses. Reconstruction of the sine-tubular junction alone was p erformed in 8 patients. Results. There was one death at 28 days. Perioperative transesophageal echo cardiography showed no or discrete AI in all patients. There has been one a ortic valve replacement at day 4 postoperatively for cusp repair failure. T ransesophageal echocardiography in 40 patients at a mean time of 12.5 month s showed no progression of AI in 38 patients, and a grade II in 2. Clinical follow-up averaged 14.5 months. There have been three late, not procedure- related deaths. Thirty-six patients are in New York Heart Association funct ional class I. There have been no cases of endocarditis. Conclusions. Aortic remodeling is successful in eliminating AI in patients with aortic root disease with minimal mortality and morbidity. Early echoca rdiography (1 year) has shown no progression of Al in 95% of cases. (C) 200 0 by The Society of Thoracic Surgeons.