Surgery of the aortic root: should we go for the valve-sparing root reconstruction or the composite graft-valve replacement is still the first choice of treatment for these patients?

• Published in: Revista brasileira de cirurgia cardiovascular Vol. 30; no. 3; pp. 343 - 352
• Main Authors: Lamana, Fernando de Azevedo, Dias, Ricardo Ribeiro, Duncan, Jose Augusto, Faria, Leandro Batisti de, Malbouisson, Luiz Marcelo Sa, Borges, Luciano de Figueiredo, Mady, Charles, Jatene, Fábio Biscegli
• Format: Journal Article
• Language: English; Portuguese
• Published: Brazil Sociedade Brasileira de Cirurgia Cardiovascular 01.07.2015
• Subjects: Adult; Aged; Aneurisma Aórtico; Aneurisma da Aorta Torácica; Aorta - surgery; Aorta Torácica; Aortic Diseases - mortality; Aortic Diseases - surgery; Aortic Valve - surgery; Bicuspid Aortic Valve Disease; CARDIAC & CARDIOVASCULAR SYSTEMS; Cardiology; Coronary vessels; Doenças da Aorta; Epidemiologic Methods; Female; Heart Defects, Congenital - mortality; Heart Defects, Congenital - surgery; Heart surgery; Heart Valve Diseases - mortality; Heart Valve Diseases - surgery; Heart Valve Prosthesis Implantation - methods; Heart Valve Prosthesis Implantation - mortality; Humans; Male; Marfan Syndrome - surgery; Middle Aged; Organ Sparing Treatments - methods; Organ Sparing Treatments - mortality; Postoperative Complications; Procedimentos Cirúrgicos Cardiovasculares; Reoperation; Reproducibility of Results; SURGERY; Surgical outcomes; Time Factors; Treatment Outcome; Cardiovascular Surgical Procedures; Aneurisma da Aorta Torácica; Aorta Torácica; Aortic Aneurysm, Thoracic; Aortic Aneurysm; Aneurisma Aórtico; Doenças da Aorta; Aorta, Thoracic; Procedimentos Cirúrgicos Cardiovasculares; Aortic Diseases
• ISSN: 0102-7638; 1678-9741; 1678-9741
• DOI: 10.5935/1678-9741.20150028

To compare the results of the root reconstruction with the aortic valve-sparing operation versus composite graft-valve replacement. From January 2002 to October 2013, 324 patients underwent aortic root reconstruction. They were 263 composite graft-valve replacement and 61 aortic valve-sparing operation (43 reimplantation and 18 remodeling). Twenty-six percent of the patients were NYHA functional class III and IV; 9.6% had Marfan syndrome, and 12% had bicuspid aortic valve. There was a predominance of aneurysms over dissections (81% vs. 19%), with 7% being acute dissections. The complete follow-up of 100% of the patients was performed with median follow-up time of 902 days for patients undergoing composite graft-valve replacement and 1492 for those undergoing aortic valve-sparing operation. In-hospital mortality was 6.7% and 4.9%, respectively for composite graft-valve replacement and aortic valve-sparing operation (ns). During the late follow-up period, there was 0% moderate and 15.4% severe aortic regurgitation, and NYHA functional class I and II were 89.4% and 94%, respectively for composite graft-valve replacement and aortic valve-sparing operation (ns). Root reconstruction with aortic valve-sparing operation showed lower late mortality (P=0.001) and lower bleeding complications (P=0.006). There was no difference for thromboembolism, endocarditis, and need of reoperation. The aortic root reconstruction with preservation of the valve should be the operation being performed for presenting lower late mortality and survival free of bleeding events.