Title : Clinical outcomes of Valve Sparing Root Replacement in Patients with Annuloaortic Ectasia
With excellent long-term outcomes of Aortic valve (AV)-sparing root replacement (VSRR) reported by expert groups, it has been regarded as a reasonable option to treat annuloaortic ectasia (AAE); however, data on VSSR outcomes from Korea have been limitedly reported. This study aims to report our long-term surgical outcomes of VSSR.
We reviewed consecutive 168 patients (48.1±15.8 years; 47 women, 18 acute aortic dissection) who underwent VSSR between 1998 and 2018. Long-term clinical outcomes and AV durability were assessed by Kaplan-Meier estimates. Multivariable Cox-proportional hazard model was used to determine risk factors of postoperative significant AI (moderate-to-severe).
During the study period, the use of VSRR among entire root replacement to treat AAE (n=158) has increased significantly over time (22.9% in 1st period-quartile to 39.4% in 4th quartile, p<0.001). Rate of Bentall-conversion was 6.0% (n=10). No early mortality occurred in the 168 VSRR patients. 5-year survival and free from reoperation were 96.0±2.1% and 90.3±3.7%, respectively, while there were no cases of endocarditis, thromboembolism or haemorrhagic events during follow-up. 5-year freedom from severe AI was 81.1±5.1%. On multivariable analyses, higher grade of preoperative AI (HR, 1.46; 95% CI 1.16-4.28; p=0.05) and low-volume surgeon (HR, 2.23; 95% CI 1.16-4.28; p=0.02) were significantly associated with the postoperative significant AI.
VSSR for aortic root dilatation has been increasingly performed, and the clinical results seem to be acceptable. Preoperative level of AI and surgeon factors were associated with the risk of postoperative AI.
Audience take away:
- David operation is an established and approved surgical procedure for the treatment of annuloaortic ectasia associated with or without aortic insufficiency
- As the surgical outcomes can be highly variable according to the operating surgeon’s experience, continuous efforts are required to pass the learning curve of this type procedure
- In our analysis, accumulation of 20 cases of this procedure was turned out to be the cut-off value predictive for surgical success. A team approach would be more reasonable for young and less-experienced surgeons