Reconstructive surgery of the aortic root

Surgical treatment of proximal aortic disease traditionally consists of composite replacement of valve and aorta. Recent reconstructive procedures on the aortic root allow for treatment of aortic dilatation and concomitant aortic valve regurgitation without the associated disadvantages of mechanical heart valves. From 10/95 to 09/99 we treated 84 patients for regurgitation of the aortic valve and dilatation of the aortic root. Valve preserving replacement of the root consisted of root remodeling (n = 68) or reimplantation of the aortic valve (n = 16). Operative mortality in valve-preserving surgery was not elevated compared to overall results of proximal aortic replacement (3.6 % VS 5.6 %); this applied to elective procedures (1.8 % vs 2.3 %) as well as emergency operations (9.3 % vs 16.3 %). Initial aortic valve function was adequate in all cases. Actuarial freedom from regurgitation grade n or higher was 98 % after root remodeling and 92 % after valve reimplantation. Freedom from reoperation at two years was 96 % in remodeling and 100 % in valve reimplantation. Hemodynamic function of the reconstructed valve was investigated in 17 patients under conditions of rest and exercise. These were compared to 9 patients with a mechanical composite valve. Patients with reconstructed valves had almost physiologic gradients during rest and exercise. These gradients were thus significantly lower than the increased gradients of patients after composite replacement. Application of reconstructive procedures to the aortic root allows for restoration of aortic valve function in the majority of patients. Disadvantages of heart valve prostheses can be avoided, and the hemodynamic performance of the reconstructed valve appears almost physiologic.