Objectives: The presence of significant preoperative aortic insufficiency (AI) or the need for cusp repair has been suggested as a risk factor for poorer outcome following aortic valve (AV) sparing surgery. We analyzed the influence of those factors on the mid-term outcomes of aortic AV surgery.
Methods: Between 1996 and 2008, 164 consecutive patients underwent elective AV sparing surgery. Severe preoperative AI (grade≥3+) was present in 93 patients (57%) and 54 (33%) had a bicuspid valve. Root repair was performed with either the reimplantation (74%) or remodeling technique (26%) and cusp repair was performed in 90 patients (55%). Mean clinical follow-up was 57 months.
Results: Hospital mortality was 0.6%. Cusp repair was required in 52% of the patients with preoperative AI≤2+ and in 57% of those with AI≥3+ (p=0.6). Cusp repair was required more frequently in bicuspid versus tricuspid valves (91% vs. 38%, p<.001). Overall survival at 8 years was 88%. Freedom from aortic valve reoperation at 8 years was similar with preoperative AI≤2+ or with preoperative AI≥3+ (89% vs. 90%, p=0.7) and with or without cusp repair (84% vs. 92%, p=0.5). Freedom from recurrent AI (grade≥3+) at 5 years was also similar between groups (90% vs. 89%, p=0.9 and 90% vs. 89%, p=0.8 respectively). By multivariate analyzes, predictors of recurrent AI≥2+ were preoperative left ventricle end-diastolic diameter and AI>1+ on discharge echocardiography.
Conclusions: With a systematic approach to cusp assessment and repair, aortic valve sparing surgery for root pathology has an acceptable mid-term outcome, irrespective of preoperative aortic insufficiency or need for cusp repair.