Valve-Sparing Aortic Root Replacement: Early Experience With the De Paulis Valsalva Graft in 51 Patients

• Published in: The Annals of thoracic surgery Vol. 82; no. 2; pp. 548 - 553
• Main Authors: Patel, Nishant D., Williams, Jason A., Barreiro, Christopher J., Bethea, Brian T., Fitton, Torin P., Dietz, Harry C., Lima, Joao A.C., Spevak, Philip J., Gott, Vincent L., Vricella, Luca A., Cameron, Duke E.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2006; Elsevier Science
• Subjects: Adolescent; Adult; Aortic Aneurysm, Thoracic - surgery; Aortic Valve - surgery; Aortic Valve Insufficiency - diagnostic imaging; Aortic Valve Insufficiency - surgery; Biological and medical sciences; Blood Vessel Prosthesis Implantation - methods; Child; Female; Heart Valve Prosthesis Implantation - methods; Humans; Male; Medical sciences; Middle Aged; Postoperative Complications - etiology; Retrospective Studies; Sinus of Valsalva - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the respiratory system; Ultrasonography; 26; Human; Experience; Treatment; Root; Respiratory disease; Surgery; Graft; Patient; Early; Replacement; Thorax; Aortic valve
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2006.03.073

Valve-sparing aortic root replacement for treatment of aortic sinus disease avoids the problems of prosthetic valves, but some patients suffer late valve incompetence as a result of leaflet distortion or annular dilatation. The reimplantation technique using the De Paulis Valsalva graft might improve late results of valve-sparing aortic root replacement by maintaining annular stability and re-creating sinuses that minimize leaflet stress. Retrospective review was conducted of all patients at our institution who underwent valve-sparing aortic root replacement using the Valsalva graft. Clinical data were obtained from hospital and clinic charts and patient contacts; echocardiograms were analyzed for aortic root dimensions and valve function. Between May 2002 and June 2005, 51 patients underwent valve-sparing aortic root replacement using the reimplantation technique with the Valsalva graft. Mean age was 33 ± 15 years; 22% (11 of 51) were children, and 80% (41 of 51) were male. Primary indication for surgery was root aneurysm in all patients. Preoperative mean root diameter was 5.0 ± 0.5 cm. Marfan syndrome was present in 67% (34 of 51), and 10% (5 of 51) had the newly described Loeys-Dietz syndrome. There were no operative or late deaths, and no patient required reoperation for bleeding. At mean follow-up of 1.8 years, there were no episodes of endocarditis or thromboembolism. Echocardiograms showed stability of the annulus and root dimensions on follow-up. No patient had more than 0 to 1+ aortic insufficiency or progression of aortic insufficiency. All were in New York Heart Association class I. Valve-sparing aortic root replacement using the Valsalva graft and reimplantation technique has excellent early results. Preservation of valve competence is encouraging, but long-term results will determine whether the anatomic design of this aortic root prosthesis is superior for preservation of valve integrity.