Effectiveness of intraoperative endoscopic evaluation in aortic valve repair with valve-sparing aortic root replacement: a comparison of short- and mid-term results

Abstract

Objectives Valve-sparing aortic root replacement requires expertise to predict repair results and prevent secondary aortic clamping for valve repair or replacement secondary to aortic valve insufficiency. Thus, intraoperative evaluation of the aortic valve using diastolic pressure at the aortic root may be helpful. This retrospective study aimed to compare the early- and mid-term results of aortic valve repair with those of valve-sparing aortic root replacement using intraoperative endoscopic evaluation. Methods We included 158 patients who underwent aortic valve repair with valve-sparing aortic root replacement at our hospital between December 2003 and January 2022. The patients were divided into a non-endoscopic evaluation group (Group NE, n = 97; mean age 55 years) and an endoscopic evaluation group (Group E, n = 61; mean age 51 years). Results The incidence of a second aortic clamping for aortic valve insufficiency was significantly greater in Group NE (17.5%) than in Group E (1.6%; p = 0.002). The presence of none or trivial aortic valve insufficiency on transthoracic echocardiography at discharge in Group E (87.6%) was significantly lower than in Group NE (98.4%; p = 0.017). No significant difference in the cumulative incidence of recurrence of moderate AI (P = 0.47), hospitalization for heart failure (P = 0.84), and reoperation (P = 0.25) between Groups NE and E. Conclusions Intraoperative endoscopic evaluation during aortic valve repair with valve-sparing aortic root replacement correlated with a lower incidence of second aortic clamping because of aortic valve insufficiency and effective aortic valve insufficiency control.