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Aortic Root Remodeling: Impact of Aortic Valve Morphology on Surgical Outcomes

This study investigates the outcomes of selective non-coronary sinus replacement in patients with aortic root aneurysms. A total of 29 patients underwent surgery between April 2003 and October 2009, with a focus on the impact of aortic valve morphology (bicuspid vs. tricuspid) on postoperative results. The findings highlight excellent early and midterm outcomes, with no mortality and low morbidity rates. The analysis suggests that selective replacement of the non-coronary sinus in cases of localized dilation is a promising surgical approach, yet underscores the need for longer follow-up and more extensive patient data.

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Aortic Root Remodeling: Impact of Aortic Valve Morphology on Surgical Outcomes

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  1. Partial aortic root remodeling with selective replacement of the non-coronary sinus: does aortic valve morphology influence outcomes? Botta L, Cannata A, Bruschi G, Trunfio S, Merlanti B, Russo CF, Taglieri C, Martinelli L.

  2. These aneurysms begin in the ascending aorta and extend into the root and arch. The pattern of root dilation is determined by pressure and flow characteristics. The sinotubular junction (STJ) enlarges first followed by the noncoronary and right coronary sinuses. Though the annulus remains stable, the respective valve cusps are retracted and splayed producing central aortic regurgitation. The left coronary sinus usually retains normal dimensions until a very advanced stage, except in patients with sitis inversus where the left sinus dilates first.

  3. Ascending Aorta and Isolated Non-Coronary Sinus Replacement

  4. Ascending Aorta and Isolated Non-Coronary Sinus Replacement MATERIALS and METHODS APRIL 2003- OCTOBER 2009 29 PATIENTS Tricuspid valve: 16 Pts (13 Males, Mean Age 65 ± 11 y) Bicuspid valve: 13 Pts (11 Males, Mean Age 52 ± 12 y)

  5. Ascending Aorta and Isolated Non-Coronary Sinus Replacement Pre-operative Features 13 pts Asc Ao and NC Sinus Rep 16 pts Asc Ao and NC Sinus Rep ETIOLOGY AORTIC ROOT ANEURYSM 13 pts RUPTURED ANEURYSM 0 pts ACUTE TYPE A DISSECTION 0 pts PSEUDOANEURYSM 0 pts ETIOLOGY AORTIC ROOT ANEURYSM 14 pts RUPTURED ANEURYSM 1 pt ACUTE TYPE A DISSECTION 0 pts PSEUDOANEURYSM 1 pts Mean Aortic Diameter 52.7 mm Mean Aortic Diameter 52.2 mm REDO 4 pts REDO 3 pts

  6. Ascending Aorta and Isolated Non-Coronary Sinus Replacement Intra-operative Data 13 pts Asc Ao and NC Sinus Rep 16 pts Asc Ao and NC Sinus Rep ASSOCIATED PROCEDURES AVR 5 pts LEAFLET PLASTY 2 pts PROSTHETIC SUTURE 2 pts ASSOCIATED PROCEDURES AVR 7 pts LEAFLET PLASTY 3 pts PROSTHETIC SUTURE 0 pts • CPB time: 136 + 44 min • Cross Clamp Time 104 + 37 min • CPB time: 147 + 60 min • Cross Clamp Time 118 + 53 min

  7. Ascending Aorta and Isolated Non-Coronary Sinus Replacement IN-HOSPITAL OUTCOMES Post-Operative stay: 7 Days (median) 30 days MORTALITY: 0 pts 30 days MORBIDITY - Stroke 1pt - Renal/Respiratory Failure 1pt 30 days MORBIDITY - Ventricular Fibrillation 1 pt - Peripheral embolism 1 pt

  8. Ascending Aorta and Isolated Non-Coronary Sinus Replacement FOLLOW-UP 100% completed Mean: 32.3 months Mean: 27.3 months LATE MORTALITY: 0 pts LATE MORBIDITY: 0 pts AORTIC DISSECTION: 0 pts RE-OPERATIONS: 0 pts

  9. CONCLUSIONS When dilatation of the aortic root is confined to the Non-coronary sinus of Valsalva, the selective replacement of this sinus may represent a good compromise, with excellent early and midterm outcomes. In patients with a bicuspid aortic valve, risk of aortic related adverse events is rare and similar to that of patients with a tricuspid valve. More patients and a longer follow-up is mandatory to confirm these preliminary results.

  10. THANKYOUFORYOURATTENTION

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