Aortic valve repair and valve sparing procedures

Valve-Sparing Aortic Root Replacement State-of-the-Art Review, Part II: Surgical Techniques

Aortic valve disease is common, and valve-preserving operations are preferred whenever possible. Valve-sparing aortic root replacement (VSRR) has become an important tool for managing aortic root pathology in children and adults. The learning curve for this operation is challenging, but with increasing experience and technical modifications, early and late outcomes continue to improve. Durable long term results vary based on underlying anatomy, pathology, and patient selection, as well as surgeon expertise. Part II of this VSRR State-of-the-Art Review article provides technical pearls related to VSRR.

Modified selective aortic root reconstruction with valve repair for treatment of Stanford A aortic dissection

Background

Acute aortic dissection is a serious emergency with a significant impact on mortality and morbidity. Many patients present with hemodynamic instability that may prevent them from being transported to more experienced centers. We aim to present our experience with a modified limited root approach in terms of the operative details and early results.

Results

This retrospective study included 27 patients who presented with Stanford A aortic dissection and underwent modified selective root replacement. All patients were followed up using transthoracic echocardiography at 6 months postoperatively and at yearly intervals thereafter. Computed tomography (CT) angiography was performed 12 months after the initial surgery.

A total of 92.6% of patients required concomitant aortic valve repair. There was no operative mortality related to the operation itself; however, four patients died during the follow-up period. One patient developed new severe aortic regurgitation in the 6th month of follow-up. One patient developed a pseudoaneurysm related to the suture line that was diagnosed by CT angiography in the 16th month of follow-up.

Conclusions

The early results of modified selective root reconstruction with aortic valve repair are promising. This procedure is a quick, reliable, easily reproducible, and technically undemanding valve-sparing treatment for acute aortic root dissection.