Key result
Valve-sparing aortic root replacement with additional cusp repair resulted in 84% freedom from aortic valve replacement at 8 years compared to 90% with V-SARR alone (P=0.218).
Why the study?
What are the mid-term survival and freedom from aortic valve-related reoperation rates after valve-sparing aortic root replacement?
Cohort (n=1,015)
Yes
What are the mid-term survival and freedom from aortic valve-related reoperation rates after valve-sparing aortic root replacement?
Mid-term survival after valve-sparing aortic root replacement is comparable to a matched general population, with excellent freedom from reoperation at 8 years.
V-SARR yields mid-term survival matching matched controls with 90% freedom from reoperation at 8 years; leaves open durability beyond this interval in unselected patients.
OBJECTIVES: The aim of this study was to characterize mortality and aortic valve replacement after valve-sparing aortic root replacement (V-SARR) in a multicentre cohort. METHODS: Between 1994 and 2014, 1015 patients had V-SARR with (n = 288, 28%) or without cusp/commissure repair (n = 727, 72%) at the centres of Lübeck (n = 343, 34%), Stuttgart (n = 346, 34%), Hamburg (n = 109, 11%) and Freiburg (n = 217, 21%), Germany. Comparative survival of an age- and gender-matched general population was calculated. Log-rank tests and multiple logistic regression were used to identify risk factors. RESULTS: The mean follow-up was 5.2 ± 3.9 years. Cumulative follow-up comprised 2933 patient-years. Early survival was 98%. NYHA status and aneurysm size were predictive of death during mid-term follow-up (P = 0.025). Freedom from aortic valve replacement was 90% at 8 years, with the type of V-SARR (root remodelling, David II) being a risk factor (P = 0.015). Bicuspid aortic valve (P = 0.26) and initial valve function (P = 0.4) did not impact reoperation. The need of additional valve repair (cusps/commissures) was not linked to reoperation: freedom from aortic valve replacement at 8 years was 84% if cusp repair was performed versus 90% if V-SARR alone was performed (P = 0.218). Marfan syndrome had no impact on survival or on aortic valve replacement. CONCLUSIONS: Mid-term survival of patients after V-SARR is comparable with that of a matched general population. The regurgitant bicuspid aortic valve is a favourable substrate for V-SARR. Prophylactic surgery should be performed before symptoms or large aneurysms are present to achieve optimal mid-term outcomes.
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Kari et al. (2015) conducted a cohort in Aortic root disease requiring surgery (n=1,015). Valve-sparing aortic root replacement with cusp/commissure repair vs. Valve-sparing aortic root replacement without cusp/commissure repair was evaluated on Freedom from aortic valve replacement at 8 years (p=0.218). Valve-sparing aortic root replacement with additional cusp repair resulted in 84% freedom from aortic valve replacement at 8 years compared to 90% with V-SARR alone (P=0.218).
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