Aortic valve disease with ascending aortic aneurysm: Impact of concomitant root-sparing (supracoronary) aortic replacement in nonsyndromic patients

Abstract

The concomitant replacement of the aorta in root-sparing fashion is associated with an excellent operative outcome and adds no additional risk to aortic valve replacement in elective and non-high-risk patients. If the distal anastomosis is performed in an open fashion, while the operative mortality is still very low, morbidities are slightly higher, but midterm survival remains comparable.

The Aortic Root: Natural History After Root-Sparing Ascending Replacement in Nonsyndromic Aneurysmal Patients

“…The root-sparing technique, used in all patients of the present cohort, replaces the ascending aorta superior to the level of the aortic valve suspension (sinotubular junction), and consequently, the coronary arteries (alternative terms: supracoronary or supracommissural), and leaves the native root tissue in situ. Sparing the root is the technically more simple approach compared with root replacement procedures (composite replacements, valvesparing, remodeling, and so forth) because of lack of coronary artery reimplantation, and results in excellent clinical outcomes [9,[19][20][21][22]. Leaving the root behind in ascending aortic replacements, both De Paulis and colleagues [23] and Park and associates [24] noted that neither a progressive dilation of nonreplaced sinuses nor an incidence of root reoperations is evident in aneurysm patients, in contrast to aortic dissection.…”

Should sinus of Valsalva be preserved in patients with bicuspid aortic valve and aortic dilation?

“…However, separate AVR and supracoronary aortic replacements are safer procedures. Peterss and colleagues (17) reported no increase in operative risk after the addition of a root-sparing ascending aorta replacement compared with isolated AVR. Studies from the University of Virginia, University of Toronto, Northwestern University, and University of Udine focusing on bicuspid valves demonstrated similarly favorable results and confirmed the safety of the root-sparing approach (18)(19)(20)(21).…”

Early and Midterm Results of 78 Ascending Aortic Aneurysm Cases after Surgical Treatment

“…Early clinical reports suggest that best results for aortic root replacement are provided with mechanical valves containing prosthetic conduits and reduce the likelihood of reoperation [11,12]. However, with increasing experience for reoperations and easier bioprosthesis, the use of biological valves has recently increased [13,14].…”