Aortic valve-sparing operation at concomitant aortic root and total aortic arch replacement.

Authors

Yu Hohri, Kavya Rajesh, Megan M Chung, Elizabeth L Norton, Christopher He, Yanling Zhao, Paul Kurlansky, Bradley Leshnower, Edward P Chen, Hiroo Takayama

Published in

General thoracic and cardiovascular surgery. Apr 23, 2025. Epub Apr 23, 2025.

Abstract

Sparing aortic valve during combined aortic root replacement (ARR) and total aortic arch replacement (TAR) adds surgical complexity; however, the long-term outcomes are unknown. We examine the safety of aortic valve-sparing during these operations.
To include patients who were potentially eligible for valve-sparing procedures, aortic stenosis, endocarditis, and previous aortic valve surgery were excluded, leaving 81 patients who underwent ARR and TAR between 2004 and 2021 at 2 major aortic centers. Overall, 34 underwent valve-sparing aortic root replacement (VSRR) and 47 underwent composite valve graft root replacement (CVG). The primary endpoint was uneventful recovery: a composite endpoint describing any patient discharged from the hospital without mortality or any postoperative complications including stroke, re-operation for bleeding, prolonged ventilation, or acute renal failure. Secondary endpoints were long-term survival and cardiovascular reintervention at 12 years.
VSRR was more frequently performed in younger patients with connective tissue disorder (P = 0.006) and less than moderate aortic insufficiency (P = 0.002). VSRR had longer cross-clamp time (243, [200-286] vs. 216, [181-250] minutes, P = 0.032). In-hospital mortality (VSRR: 5.9% vs CVG: 10.6%, P = 0.693) and uneventful recovery (VSRR: 47.1% vs CVG: 44.7%, P = 1.000) were not different. Multivariable Logistic regression showed that VSRR was not associated with the uneventful recovery (OR 1.165, 95% CI [0.356-3.814], P = 0.801). Twelve-year survival (VSRR: 80.8% [63.1-100.0%] vs. CVG: 66.3% [47.9-91.7%]; P = 0.320) and the incidence of reintervention (VSRR: 39.0% [19.0-59.0%] vs. CVG: 39.0% [16.0-61.0%], P = 0.820) were similar between groups.
In appropriately selected patients requiring concomitant ARR and TAR, aortic valve-sparing operation may be performed safely.

PMID:
40266547
Bibliographic data and abstract were imported from PubMed on 23 Apr 2025.

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