Cor Vasa 2011, 53(10):542-546 | DOI: 10.33678/cor.2011.134

Our first experience with aortic valve sparing operations

František Sabol¹, Adrian Kolesár^1,*, Ján Luczy¹, Gabriel Valočík², Anton Bereš¹, Lucia Mistríková¹, Martin Beňa¹, Martin Ledecký¹, Marta Jakubová³, Peter Čandík³, Imrich Sopko³, Povol Török³, Jozefína Cocherová³, Jana Jevčáková¹, Ingrid Schusterová¹, Matúš Marcin⁴, Martin Vaľko⁴

¹ Klinika srdcovej chirurgie, Lekárska fakulta UPJŠ a VÚSCH, a.s., Košice, SR

² Kardiologická klinika, Lekárska fakulta UPJŠ a VÚSCH, a.s., Košice, SR

³ Klinika anastézie a intenzívnej medicíny, Lekárska fakulta UPJŠ a VÚSCH, a.s., Košice, SR

⁴ Klinika srdcovej chirurgie, Úsek perfuziológie a podporných systémov, LF UPJŠ a VÚSCH, a.s., Košice, SR

Aim: To evaluate short- to mid-term outcomes of aortic valve sparing operations performed at our hospital.

Methods: In the period from January 2008 to August 2010, the total of aortic root reconstructions including aortic valve sparing operations were performed at the Clinic of Cardiac Surgery, University Hospital UPJŠ, Košice. Only 15 patients were included in the follow-up, one patient died in an early postoperative period and one patient required early reoperation with aortic valve replacement. The average age of the patients was 55 ± 9 years. The average grade of aortic regurgitation before the surgery was 2.44 ± 1.2. Dilatation of aortic root, as a cause of aortic regurgitation, was detected in 12 patients, in two patients acute aortic dissection was the cause, and in three cases there was a simple malcoaptation of the leaflets of aortic valve. In five cases we performed supracoronary graft replacement of ascending aorta, in eight cases graft replacement of ascending aorta combined with reimplantation of aortic valve, in next two remodeling of aortic root and finally the isolated aortic valve repair was performed in two patients. All of the root procedures were combined with the leaflet procedures. The follow-up was completed in 11 patients (73.3%).

Results: The average duration of extracorporeal circulation (ECC) was 159 ± 44 min, the average time of cardioplegic arrest was 126 ± 48 min. One death occurred in a patient with an acute dissection due to multiorgan failure (MOF) caused by malperfusion syndrome. Early reoperation was required in one patient as a result of a repair failure. The average grade of aortic regurgitation was decreased from 2.44 ± 1.2 before the surgery to 0.81 ± 0.56 in postoperative period (p < 0.01). The follow-up lasted 10 (3-28) months. Analysis of all patients who completed the follow-up shows that aortic regurgitation < 2 was verified in nine patients (81.8%), aortic regurgitation = 2 in two patients (18.2%). In the period from August 2010 to January 2011, we performed successful aortic valve sparing operations in additional four patients, however, they have not been included in our study group yet.

Conclusion: According to our results we can conclude that even though the aortic valve sparing operations require greater technical skills they can be performed with an acceptable postoperative morbidity and mortality ratio, and in certain cases they represent interesting alternative to a valve replacement with potential advantages for patients.

Keywords: Aortic root aneurysm; Aortic regurgitation; Aortic valve sparing operations; Leaflet prolapse; Aortic root remodeling; Aortic valve reimplantation

Published: October 1, 2011  Show citation