Annuloaortic repair in the treatment of aortic regurgitation and aortic root pathology

We developed a new technique of aortic root repair which may be able to eli minate the potential problem of leaflet damage, resulting from the direct c ontact of the aortic leaflets with synthetic vascular grafts during systole . This report describes our technique of annuloaortic repair and the operat ive results. Between February 1995 and October 1998, 13 patients underwent annuloaortic repair. The patients included 8 males and 5 females (mean age 50 years). Four patients had grade IV/IV aortic regurgitation (AR), 5 had I II/IV AR, 2 had II/IV AR, and 1 had no AR preoperatively. Regarding the pre operative functional status, 1 patient was classified as New York Heart Ass ociation class IV, 5 were class III, 6 class II, and 1 class I. Concomitant cardiovascular procedures were performed in 12 cases. Aortic valvuloplasty or annuloplasty was performed in 7 patients. Both operative and short-term postoperative results with pre- and postoperative echocardiographic findin gs were studied retrospectively. The mean total cardiopulmonary bypass time was 212 min. The mean aortic cross-clamp time was 130 min. Circulatory arr est was induced ill 5 patients. Postoperatively, 7 patients had no AR. Thre e patients had grade I/IV AR and 3 had grade II/IV AR. Perioperative change s in aortic annulus, mid-sinus portion, and sinotubular junction diameters were determined echocardiographically in 5 patients. The pre operative diam eters were 2.7 +/- 0.4, 5.4 +/- 0.5, and 4.7 +/- 1.0 cm, respectively. The postoperative diameters were 2.3 +/- 0.5, 3.2 +/- 0.5, and 3.5 +/- 0.5 cm, respectively. Ten patients were class I and 2 were class II. This technique of annuloaortic repair with or without aortic valvuloplasty is applicable to a certain subset of patients with aortic root disease and AR. Both the i ndications for this procedure and the long-term results should be confirmed .