Impact of preoperative aortic root diameter on long-term aortic valve function after valve sparing aortic root reimplantation

Background - Valve sparing aortic root reimplantation technique in patients with aortic root aneurysm have shown excellent mid-term results. In conjunction with the diameter of the aortic root the mechanical leaflet stress increase, which might have an impact on long-term aortic valve function after valve sparing aortic root reimplantation. Methods and Results - From July 1993 to October 2001, 168 patients with aortic root aneurysm underwent valve sparing aortic root reimplantation. Patients with type A aortic dissection were excluded. Thus, 123 patients were analyzed. We identified 47 patients with an preoperative aortic root diameter exceeding 60 mm ( group A), 58 patients with an diameter between 50 and 60 mm ( group B), and 18 patients with a diameter less than 50 mm ( group C). The groups were compared regarding mortality, long-term survival, freedom from reoperation, freedom from severe and moderate aortic valve insufficiency ( AI), and postoperative morbidity. Mean follow-up ( group A 43 +/- 26 months, group B 40 +/- 25 months, group C 23 +/- 19 months; group C versus group A, P = 0.005; group C versus group B, P = 0.011) was shorter in group C. Perioperative mortality ( group A 2.2%, group B 1.9%, group C 5.2%; P = ns) was comparable between the groups with each one patient. The 3-year survival for group A was 98 +/- 2%, for group B 96 +/- 3%, and for group C 100 +/- 0% ( P = ns). Freedom from reoperation for group A was 98 +/- 2%, for group B 96 +/- 3%, and for group C 88 +/- 8% (P = ns). Four patients developed severe or moderate AI, thus freedom from severe and moderate AI for group A was 100 +/- 0%, for group B 88 +/- 8%, and for group C 94 +/- 5% ( P = ns). During follow-up no thromboembolic or bleeding events were noticed. Conclusions - Our data show that the preoperative diameter of the aortic root has no impact on the longevity of the repair. Thus, the reimplantation technique can be recommended for all patients presenting with an aortic root aneurysm and normal leaflets regardless of the aortic root diameter.