J Thorac Cardiovasc Surg. 2024 Jun 22:S0022-5223(24)00535-X. doi: 10.1016/j.jtcvs.2024.06.013. Online ahead of print.
ABSTRACT
OBJECTIVES: In remodeling valve sparing root replacement with external annuloplasty, we compare long-term outcomes of calibrated expansible Extra-Aortic Ring to homemade Dacron ring.
METHODS: All patients (2003-2020) operated for root aneurysm with/without AI were included. The standardized CAVIAAR technique was root remodeling and external annuloplasty ring, with Extra-Aortic Ring or homemade Dacron ring.
RESULTS: Among 486 patients (age: 52.3±14.0 years) operated for root aneurysm, 375 (repair rate: 77.1%) underwent root remodeling with annuloplasty (Extra-Aortic Ring (n=289) vs Dacron ring (n=86)). At 10 years (median follow-up: 4.08 years, IQR [1.95,7.61]), unmatched and matched analysis showed that patients with Extra-Aortic Ring had higher survival, similar to the general population (93.3% vs 79.9%, p=0.097), lower reoperation incidence (2.0% vs 9.7%, p=0.0098) and lower AI grade>2 recurrence (1.9% vs 11.2%, p=0.0042), compared to patients with Dacron ring. Mixed-effect model showed that with Extra-Aortic Ring annuloplasty, annular dilation over time (p=0.0033) was prevented and, compared to homemade Dacron ring, root expansibility was better preserved (3.22% vs 2.12%, p=0.002) and mean transvalvular gradient was lower (6.58mmHg vs 7.94mmHg, p=0.001). Tricuspid and bicuspid valves with Extra-Aortic Ring had similar reoperation (4.3% vs 0.85%, p=0.65) and AI grade>2 incidence (2.7% vs 1.2%, p=0.61), expansibility (p=0.29) and diameter (p=0.47), while mean transvalvular gradient was lower for tricuspid valves (5.58mmHg vs 7.60mmHg, p=0.004).
CONCLUSIONS: Valve sparing root remodeling with calibrated expansible Extra-Aortic Ring annuloplasty improves outcomes of reoperation and recurrent AI, compared to homemade Dacron ring. It prevents dilation and maintains physiological root dynamics for durable valve repair.
PMID:38914371 | DOI:10.1016/j.jtcvs.2024.06.013
