Abstract
Aim: To evaluate medium to long-term outcomes of aortic valve - sparing procedures and identify risk factors for procedure failure. Methods: From 11/2007 to 10/2017, a total of 198 aortic valve sparing operations were performed at our department.
The mean age of patients was 48.4+-13.5 years. Preoperatively, the mean grade of aortic regurgitation was 3.4+-1.1.
Aortic root dilation and cusp prolapse were main causes of aortic regurgitation (in 106 and 92 cases, respectively). Results: Out of a total of 198 operations, supracoronary aortic root replacement (24), reimplantation of the aortic valve (11), remodeling of the aortic root (71) combined in 66 patients with implantation of the external annuloplasty ring, and 92 aortic cusp interventions were performed.
Thirty-day mortality was 0%. The median follow-up is 2.8 years (194 patients).
During this period, 4 patients died. Nineteen patients were reoperated (9.5%); 15 for reccurrent aortic regurgitation, 1 for development of aortic stenosis, 2 for vascular graft infection and 1 for aortic root pseudoaneurysm.
At reoperation 1 valve repair, 14 replacements with a mechanical prosthesis and 1 with bioprosthesis (1 with pseudoaneurysm closure), and 2 aortic root repůacements with a homograft were performed. The leading cause of aortic regurgitation recurrence was cusp reprolapse and aortic annulus redilation (9 cases).
Aortic valve restriction and retraction were other causes of repair failure (6 cases). Conclusion: Aortic valve-sparing operations should be considered the method of choice in selected patients.
Echocardiography correctly distinguishes the anatomy suitable for aortic valve repair, determines the optimal type of procedure, evaluates its outcome, and identifies the presence of risk factors for failure of aortic valve reconstruction.