Early Results of Aortic Valve-sparing Procedures in Patients with Annuloaortic Ectasia

Sung, Kiick; Park, Pyo Won; Park, Kay Hyun; Lee, Young Tak; Jun, Tae Gook; Yang, Ji Hyuk; Kim, Su Wan; Kim, Jin Sun; Cho, Sung Woo; Kim, Si Wook; Choi, Jin Ho

Abstract

BACKGROUND: Aortic valve-sparing procedures could reduce valve-related morbidity, but may increase operative risks; therefore, these procedures could not be performed routinely. We attempted to find out the early results while focusing on the operative risks associated with these procedures in our hospital. MATERIAL AND METHOD: From May 1996 to July 2003, 26 patients underwent these procedures including 15 patients with Marfan syndrome and 1 patient with Behcet disease. There were 17 men and 9 women with mean age of 37.9+/-19.2 years (range: 6 months~74 years). Ten patients had ascending aortic dissection, 18 patients had more than moderate degree of aortic valve insufficiency (AI). Two types of valve-sparing procedures were performed: valve reimplantation in 14 and root remodeling in 12 patients. Associated procedures were performed as follows: aortic valve plasty in 6, mitral valve plasty in 5, hemi-arch replacement in 4, total arch replacement in 2, coronary artery bypass surgery in 1 and Maze procedure in 1 patient(s). RESULT: In four patients, valve-sparing procedures were converted to Bentall procedures during operation. Including these patients, there was no operative deaths, 3 patients underwent re-operation due to bleeding, 1 patient had permanent pacemaker. The median duration of ICU stay was 45.5 hours, the median duration of hospital stay was 10.5 days. In 22 patients excluding 4 converted patients, intra- operative transesophageal echocardiogram (TEE) showed less than mild degree of AI in all except one who had not received intra-operative TEE in the beginning and showed moderate degree of AI at discharge. The mean duration of follow-up was 21.2+/-27.4 months. All patients were alive except one who died during other departmental surgery. In 3 patients, more than moderate degree of AI was recurred, but there were no re- operation.
CONCLUSION
Aortic valve-sparing procedures could be performed relatively safely in selected patients who had annuloaortic ectasia.