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Ann Thorac Surg 2002;74:2026-2033
© 2002 The Society of Thoracic Surgeons

Original article: cardiovascular

Results of valve-sparing aortic root reconstruction in 158 consecutive patients

Klaus Kallenbach, MDa*, Christian Hagl, MDa, Thorsten Walles, MDa, Rainer G. Leyh, MDa, Klaus Pethig, MDa, Axel Haverich, MDa, Wolfgang Harringer, MDa

a Department of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany

* Address reprint requests to Dr Kallenbach, Hannover Medical School, Department of Thoracic and Cardiovascular Surgery, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
e-mail: kallenbach{at}thg.mh-hannover.de

Presented at the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.

BACKGROUND: This study assesses the durability and clinical outcome of valve-sparing aortic root reconstruction using the reimplantation technique in a single center cohort.

METHODS: From July 1993 to July 2001, 158 patients underwent replacement of the ascending aorta with native valve reimplantation. Mean age of patients was 52 ± 17 years (9 to 84 years), 103 were men (65%). Thirty-four patients (22%) suffered from Marfan’s syndrome. Aortic dissection Stanford type A was present in 29 patients (19%) (22 acute, 7 chronic), and concomitant partial or total arch replacement was necessary in 57 patients (36%). One or more additional procedures were performed in 28 patients (18%). Mean follow-up was 36 ± 25 months (0.4 to 96 months).

RESULTS: Thirty-day mortality was 3.8% (6 patients), but only 2.2% in elective patients. Mean bypass time was 169 ± 50 minutes (99 to 440 minutes), aortic cross-clamp time was 129 ± 31 minutes (79 to 205 minutes). In patients undergoing arch replacement, circulatory arrest was 26 ± 18 minutes (7 to 99 minutes). During follow-up, there were 5 (3.3%) cardiac-related late deaths. Grade of aortic insufficiency (AI) decreased from 2.3 ± 1.1 (0 to 4) preoperatively to 0.23 ± 0.44 (0 to 2) postoperatively (p < 0.0001). Six patients required aortic valve replacement, 4 of those due to progressive AI. Average grade of AI increased significantly to 0.42 ± 0.61 (0 to 3) at latest evaluation (p = 0.002). Two patients experienced a transient ischemic attack within the first postoperative week. No further thromboembolic complications were noticed. All patients presented with a favorable exercise tolerance.

CONCLUSIONS: The aortic valve reimplantation technique achieves excellent clinical outcome with few complications even in complex pathologies. Lack of anticoagulation and favorable durability encourage wider and earlier use of this technique.




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