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Original Articles: Adult Cardiac

Adjustment of Sinotubular Junction for Aortic Insufficiency Secondary to Ascending Aortic Aneurysm

Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan

Accepted for publication May 13, 2009.

^_* Address correspondence to Dr Morimoto, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine 7-5-1, Kusunoki-cho, chuo-ku, Kobe, Hyogo, 650-0017, Japan (Email: naotofrcs{at}gmail.com).

Background: Dilatation of the sinotubular junction (STJ) causes aortic regurgitation (AR) in patients with ascending aneurysm. These patients can regain valve competence by simple reduction of the diameter of STJ. Results of this technique were investigated clinically and echocardiographically.

Methods: Replacement of the ascending aorta with reduction of the diameter of the STJ to correct AR (mean grade, 2.7 ± 0.7) was performed in 29 consecutive patients (mean age, 73.2 ± 6.2). Two required repair of cusp prolapse. All underwent ascending aortic aneurysm replacement. Echocardiographic studies were performed at discharge and during latest clinical follow-up (mean follow-up, 3.8 ± 2.5 years).

Results: No hospital deaths occurred. The AR grade at discharge was 0.7 ± 0.5. No valve related-deaths occurred. Actual survival at 8 years was 91% ± 9%. Failure occurred 4.1 years postoperatively in a patient with bicuspid valve. Three patients had late recurrence of AR that was caused by aortic root dilatation in bicuspid valves in 2. Multivariate analysis showed bicuspid aortic valve was the predictor of late progression of AR. The freedom from more than grade II AR at 8 years was 79.5% ± 10.7%.

Conclusions: Adjustment of the diameter of STJ could treat AR secondary to ascending aortic aneurysm with nearly normal aortic cusps. Midterm results of this procedure were acceptable. Although bicuspid aortic valve is the risk factor for late AR due to dilation of remaining aortic root, this procedure provides satisfactory long-term outcomes among the patients with tricuspid valve.