Early Experience of Aortic Valve Preserving Operations in Patients with Aneurysms of the Ascending Aorta and Aortic RootG. El Khoury, M. Underwood, D. Glineur, D. Derouck, Ph. Noirhomme, R. Dion
Cliniques Universitaires Saint-Luc, Brussels, Belgium
Despite the presence of normal valve leaflets, aortic insufficiency (AI) is often present in aortic root aneurysms. To preserve the valve, aortic remodelling, by excising the aortic root and sinuses, resuspending the leaflets and re-implanting the coronary ostia into a scalloped Dacron graft was performed in 36 patients (pts) between July 1995 and April 1998. Mean age was 50yrs, and 20 pts were in NYHA III. There were 9 type A dissections (6 acute, 3 semi-acute) and 6 Marfans. Preoperative echocardiography (TOE) showed AI grade 3 or 4 in 26 pts, an annular diameter of > 28mm in 6 pts (mean 24 mm). Twenty-two pts underwent replacement of all 3 sinuses, 6 pts the non-coronary sinus only, 3 pts the non-coronary and right coronary sinuses and 1 the right coronary sinuses. Remodelling of the sino-tubular junction was performed in 4 pts. Four pts had an aortic annuloplasty and 2 pts resection of a median raphe (bicuspid valve). There were 2 re-operations for bleeding (1 late tamponade). There was one death in hospital at 28 days (aspiration pneumonia, previous radiotherapy for oesophageal carcinoma). Peri-operative TOE showed no or discrete AI in 34 pts, Grade I in 2 pts. TOE performed at discharge (mean 10 days) showed Grade I AI in 3 pts. Late TOE has been performed in 32 pts at mean 13 months (range 1-28) and has shown no progression of AI. Mean clinical follow up is 15.5 months (1-28). There have been 3 late deaths (3 months: acute hepatitis, 12 months: cerebral haemorrhage, 14 months: unknown). 90% of the survivors are in NYHA I. There have been no re-operations and no endocarditis. Valve preserving operations can be performed safely in a large proportion of pts with aneurysms of the ascending aorta and root. Early clinical and echocardiographic results are promising. Long-term follow up is now in progress to determine the durability of this procedure.
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