Abstract
Background This study aimed to assess predictors of a composite endpoint (reoperation for aortic
valve [AV] failure or aortic regurgitation [AR] grade ≥ 2) after reimplantation of
the aortic valve (RAV) using the Valsalva graft.
Methods From 2012 to 2021, 112 patients underwent RAV in a single center. Clinical and echocardiographic
data were collected retrospectively. Cox regression analysis was used to identify
predictors of the composite endpoint. Kaplan–Meier methods were used for time-to-event
analysis.
Results Median (interquartile range) age was 52 years (44, 62). Nineteen patients (17%) were
operated for acute Type A aortic dissection, and the remainder for aortic root aneurysm,
60 mm or larger in 12/112 (11%). Thirty-day mortality was 1/112 (1%). During follow-up,
four patients (3.6%) were reoperated for AV failure, and another nine patients (8.1%)
developed AR grade ≥ 2. Overall estimated freedom from reoperation or AR grade ≥ 2
was 87% (95% confidence interval: 76–93%) at 5 years. Significantly lower estimated
5-year freedom from the composite endpoint was found in cases with simultaneous aortic
valve repair (AVr; 77 vs. 90%, p = 0.007) and nearly significant for large (≥ 6 cm) aortic root diameter (82 vs. 87%,
p = 0.055). In Cox's analysis, aortic root diameter and simultaneous AVr were independent
predictors for the composite endpoint.
Conclusion Outcomes (survival, reoperation, freedom from AR grade ≥ 2) with RAV were good up
to 11-year follow-up. Larger aortic root diameter and simultaneous AVr were identified
as predictors for reoperation or AR grade ≥ 2. Long-term follow-up remains necessary
to confirm adequate AV function.
Keywords
reimplantation of the aortic valve - valve-sparing root replacement - aortic valve
reimplantation - David procedure
