Cor Vasa 2009, 51(11-12):781-788 | DOI: 10.33678/cor.2009.192

Aortic valve-sparing surgery-early and mid-term outcomes

Jan Vojáček^1,*, Martin Tuna¹, Soňa Vaneková¹, Jan Dominik¹, Pavel Žáček¹, Pavel Polanský¹, Miroslav Brtko¹, Pavel Nedbal², Peter Telekes², Jan Harrer¹

¹ Kardiochirurgická klinika, Fakultní nemocnice Hradec Králové, Univerzita Karlova v Praze a Lékařská fakulta v Hradci Králové, Hradec Králové

² Kardiocentrum, Krajská nemocnice Liberec a. s., Liberec, Česká republika

Aim: To determine short- to mid-term outcomes of aortic valve-sparing surgery and aortic valvuloplasty.

Methods: A total of 28 aortic valve-sparing surgical and aortic valvuloplasty procedures were performed at the Department of Cardiac Surgery of Hradec Králové University Hospital from November 2007 through June 2009. The mean age of surgical patients was 51 ± 15 years. Preoperatively, the mean degree of aortic regurgitation was 3.5 ± 0.8, ejection fraction (EF) 54 ± 10%, and left ventricular end-diastolic dimension (EDD) 60 ± 10 mm. Overall, functional aortic regurgitation caused by altered aortic root geometry was observed in 16 patients. Cusp prolapse was diagnosed in 12 patients. Of the total of 28 procedures, surgery involved the aortic root or the ascending aorta in 16 cases (supracoronary ascending aorta replacement in four, aortic valve remodeling in three, and aortic valve reimplantation in nine cases). In 12 patients, the procedure involved aortic valve cusps (with the bicuscpid valve in 11 cases).

Results: Mean extracorporeal circulation ECC and cardioplegic heart arrest times were 120 ± 57 minutes and 93 ± 49 minutes, respectively. Thirty-day mortality was 0%. Early, in-hospital, echocardiographic results: aortic function improved, mean preoperative degree of aortic regurgitation of 3.5 ± 0.8 decreased to 1 ± 0.8. Mean postoperative peak (PGmax) and medium gradients (PGmean) on the aortic valve were 18 ± 10 mm Hg and 10 ± 6 mm Hg, respectively. Adequate or satisfactory depth of coaptation above or at aortic annulus level was obtained in all patients. Mean left ventricular EF increased from 54 ± 10% to 57 ± 6% (p = 0.1), LV EDD decreased from 60 ± 10 mm to 53 ± 8 mm (p = 0.001). Mean follow-up is 9 ± 6 months, and survival rate 100%. Ninety-four percent of patients are free of aortic regurgitation > 2, none patient required re-do surgery.

Conclusion: Aortic valve-sparing surgery is a promising method and, if properly indicated, it can be considered the method of choice in managing the types of aortic regurgitation that are already clearly defined today.

Keywords: Bicuspid aortic valve; Aortic root aneurysm; Aortic valve-sparing surgery; Aortic root remodeling; Aortic valve re-implantation

Published: November 1, 2009  Show citation