Effects of Preoperative Aortic Insufficiency on Outcome After Aortic Valve–Sparing Surgery

Abstract

Background— The presence of significant preoperative aortic insufficiency (AI) or the need for cusp repair has been suggested as a risk factor for poorer outcomes after aortic valve (AV)–sparing surgery. We analyzed the influence of these factors on the mid-term outcomes of AV surgery. Methods and Results— Between 1996 and 2008, 164 consecutive patients underwent elective AV-sparing surgery. Severe preoperative AI (grade ≥3+) was present in 93 patients (57%), and 54 (33%) had a bicuspid valve. Root repair was performed with either the reimplantation (74%) or the remodeling (26%) technique, and cusp repair was performed in 90 patients (55%). Mean clinical follow-up was 57 months. Hospital mortality was 0.6%. Cusp repair was required in 52% of the patients with preoperative AI ≤2+ and in 57% of those with AI ≥3+ ( P =0.6). Cusp repair was required more frequently in bicuspid versus tricuspid valves (91% versus 38%, P <0.001). Overall survival at 8 years was 88±8%. Freedom from AV reoperation at 8 years was similar with preoperative AI ≤2+ versus preoperative AI ≥3+ (89±11% versus 90±7%, P =0.7) and with versus without cusp repair (84±17% versus 92±8%, P =0.5). Freedom from recurrent AI (grade ≥3+) at 5 years was also similar between groups (90±10% versus 89±8%, P =0.9, and 90±8% versus 89±9%, P =0.8, respectively). By multivariate analyses, predictors of recurrent AI ≥2+ were preoperative left ventricle end-diastolic diameter and AI >1+ on discharge echocardiography. Conclusions— With a systematic approach to cusp assessment and repair, AV-sparing surgery for root pathology has an acceptable mid-term outcome, irrespective of preoperative AI or need for cusp repair.