Valve-sparing aortic root replacement in adult patients with congenital heart disease. (19th July 2021)

• Record Type: Journal Article
• Authors: Bobylev, Dmitry; Avsar, Murat; Sarikouch, Samir; Cvitkovic, Tomislav; Boethig, Dietmar; Westhoff-Bleck, Mechthild; Bertram, Harald; Beerbaum, Philipp; Haverich, Axel; Horke, Alexander
• Is Part Of: Interactive cardiovascular and thoracic surgery. Volume 33:Number 6(2021)
• Page Start: 959
• Page End: 965
• Publication Date: 2021-07-19
• Subjects: Congenital heart disease -- Aortic root dilatation -- Valve-sparing aortic root replacement; Chest -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; 616.1
• DOI: 10.1093/icvts/ivab189
• Languages: English
• ISSNs: 1569-9293

Abstract

Abstract: : OBJECTIVES: Aortic root dilatation is frequently observed in patients with congenital heart defects (CHD), but has received little attention in terms of developing a best practice approach for treatment. In this study, we analysed our experience with aortic valve-sparing root replacement in patients following previous operations to repair CHD. METHODS: In this study, we included 7 patients with a history of previous surgery for CHD who underwent aortic valve-sparing operations. The underlying initial defects were tetralogy of Fallot ( n = 3), transposition of great arteries ( n = 2), coarctation of the aorta ( n = 1), and pulmonary atresia with ventricle septum defect ( n = 1). The patients' age ranged from 20 to 40 years (mean age 31 ± 6 years). RESULTS: David reimplantation was performed in 6 patients and a Yacoub remodelling procedure was performed in 1 patient. Four patients underwent simultaneous pulmonary valve replacement. The mean interval between the corrective procedure for CHD and the aortic valve-sparing surgery was 26 ± 3 years. There was no operative or late mortality. The patient with transposition of great arteries following an arterial switch operation was re-operated 25 months after the valve-sparing procedure due to severe aortic regurgitation. In all other patients, the aortic valve regurgitation was mild or negligible at the latest follow-up (mean 8.7 years, range 2.1–15.1 years). CONCLUSIONS: Valve-sparing aortic root replacement resulted in good aortic valve function during the first decade of observation in 6 of 7 patients. This approach can offer a viable alternative to root replacement with mechanical or biological prostheses in selected patients following CHD repair. Abstract : Aortic valve-sparing operations are well-established procedures to treat adult patients with aortic root aneurysms with excellent long-term clinical outcomes in expert centres [1, 2].