Valve-sparing aortic root repair with patch technique.

Abstract

In the valve-sparing aortic root repair technique presented, each pathologic sinus is replaced with a teardrop-shaped patch. In this study, the clinical and echocardiographic results after the first 20 procedures are evaluated. Between September 2000 and May 2004, 20 patients underwent aortic root repair using a patch technique. Eight patients had an acute type A aortic dissection and 12 patients had an aneurysm of the ascending aorta. In 12 cases, the aortic root was reconstructed with three patches, in 1 case with two patches, and in 7 cases with one patch. The postoperative echocardiography at discharge showed no aortic regurgitation in 15 cases and trivial regurgitation in 5 cases. Three patients with aortic dissection as an initial pathologic diagnosis died during a median follow-up period of 14.5 months (range, 0.5 to 32 months). At the time of follow-up, the echocardiographic findings in all 17 survivors remained unchanged from the early postoperative examinations. Median peak and mean transvalvular gradients were 8 mm Hg (range, 3.2 to 14 mm Hg) and 4 mm Hg (range, 1.7 to 6 mm Hg), respectively. The technique presented allows an individualized reconstruction of the sinuses of Valsalva, a simplified sizing of the vascular graft, and the creation of a new sinotubular junction resulting in good hemodynamic conditions. The technique is especially advantageous in patients in whom replacement of all sinuses is not necessary.