K. YIN1, Y. Lin1, Z. Zhang1, Y. Wang1, C. Wang1 1Zhongshan Hospital Fudan University,Department Of Cardiac Surgery,Shanghai, SHANGHAI, China
Introduction:
Sinus of Valsalva aneurysms (SVAs) are rare and often complicated by aortic valve insufficiency (AI). While aneurysms can be repaired successfully by various techniques, treating aortic regurgitation is the key to achieving good long-term results. We summarized our experience on the surgical management of concomitant AI in this patient population.
Methods:
We identified 178 patients (age 37.4±13.1 years old, 114 males) who underwent SVAs repair in our institution from 2008-2015, of whom 87 (48.9%) had at least mild AI preoperatively. Concurrent aortic valve (AV) surgery was performed in 70 patients (39.3%), divided into 63 AVRs (61 mechanical vs 2 tissue valves, including 6 root replacement) and 7 AV repairs (3 subcommissural annuloplasty, 2 valve resuspension, 2 David I procedure). Seventeen patients had aneurysm repair only. Mean follow-up time was 44.4 ± 33.8 months.
Results:
Compared to patients with normal AV, the group with AI has a higher incidence of right coronary sinus aneurysm with concomitant VSD (50/91 vs 70/87, p < 0.05). Among the AVR patients, 6 were redo cases: 5 of which presented with moderate to severe to severe AI after their first SVAs ± VSD repair procedure, while the other one underwent redo-sternotomy, root replacement for chronic type A dissection 15.2 months after his initial SVAs repair. All AV repair patients (7/7) had trivial to mild AI during follow up (mean follow up time 36.1 ± 37.9 months, 3.6-100.0 months), while 3 of the 17 “aneurysm repair only” patients presented with moderate AI (mean follow-up time 44.6 ± 36.2 months, 1.1-99.8 months). There was no early death in our series, but with one late mortality in a patient who had sudden death 8 weeks after his SVAs + VSD patch closure.
Conclusion:
Concomitant aortic insufficiency can be managed by various surgical techniques without compromising short-term outcomes. Although valve replacement has been known to have good long-term results, AV repair techniques, especially valve sparing procedure in young patients is an acceptable option when performed by experienced surgeons.