Abstract
Background
Root remodeling is one form of valve-preserving root replacement to treat patients with aortic regurgitation (AR) and root aneurysm. We have consistently used it for patients with and without connective tissue disease and different aortic valve morphologies. The objective of this retrospective study was to review 23 years of experience with root remodeling.
Methods and patients
Between 10/95 and 9/2018, 1004 of 1038 root remodeling procedures were performed in patients with tricuspid (n = 589) or bicuspid (n = 414) anatomy of the aortic valve in our institution. Aortic aneurysm was present in 932 cases, 73 procedures were performed for acute aortic dissection type A. The severity of aortic regurgitation ranged from grade I to grade IV (mean 2.5 ± 0.8).
Results
All patients underwent root remodeling, concomitant operations were performed in 433, and cusp repair in 883 instances. Hospital mortality was 2%. Overall freedom from reoperation was 92% at 10 years and 89% at 15 years. It was 94% for tricuspid valves at 10 and 15 years, and 88% for bicuspid aortic valves at 10 years and 80% at 15 years (p = 0.003).
Conclusion
In conclusion, root remodeling is a viable option in valve-preserving root replacement. If combined with careful assessment and, if necessary, correction of aortic valve form reproducible restoration of aortic valve function can be achieved.
Similar content being viewed by others
References
Sarsam MA, Yacoub M. Remodeling of the aortic valve anulus. J Thorac Cardiovasc Surg. 1993;105:435–8.
Luciani GB, Casali G, Tomezzoli A, Mazzucco A. Recurrence of aortic insufficiency after aortic root remodeling with valve preservation. Ann Thorac Surg. 1999;67:1849–52.
Leyh RG, Fischer S, Kallenbach K, et al. High failure rate after valve-sparing aortic root replacement using the "remodeling technique" in acute type A aortic dissection. Circulation. 2002;106:I229–33.
Yacoub MH, Gehle P, Chandrasekaran V, Birks EJ, Child A, Radley-Smith R. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg. 1998;115:1080–90.
Erasmi AW, Sievers HH, Bechtel JF, Hanke T, Stierle U, Misfeld M. Remodeling or reimplantation for valve-sparing aortic root surgery? Ann Thorac Surg. 2007;83:S752–6.
Aicher D, Langer F, Lausberg H, Bierbach B, Schäfers HJ. Aortic root remodeling: ten-year experience with 274 patients. J Thorac Cardiovasc Surg. 2007;134:909–15.
Langer F, Graeter T, Nikoloudakis N, Aicher D, Wendler O, Schäfers HJ. Valve-preserving aortic replacement: does the additional repair of leaflet prolapse adversely affect the results? J Thorac Cardiovasc Surg. 2001;122:270–7.
Asano M, Kunihara T, Aicher D, El Beyrouti H, Rodionycheva S, Schäfers HJ. Mid-term results after sinutubular junction remodelling with aortic cusp repair. Eur J Cardiothorac Surg. 2012;42:1010–5.
Schäfers HJ, Aicher D, Langer F, Lausberg HF. Preservation of the bicuspid aortic valve. Ann Thorac Surg. 2007;83:S740–5.
Langer F, Aicher D, Kissinger A, et al. Aortic valve repair using a differentiated surgical strategy. Circulation. 2004;110:II67–73.
Schäfers HJ, Bierbach B, Aicher D. A new approach to the assessment of aortic cusp geometry. J Thorac Cardiovasc Surg. 2006;132:436–8.
Lansac E, Di Centa I, Sleilaty G, et al. An aortic ring: from physiologic reconstruction of the root to a standardized approach for aortic valve repair. J Thorac Cardiovasc Surg. 2010;140:S28–35.
Schäfers HJ, Aicher D. Root remodeling for aortic root dilatation. Ann Cardiothorac Surg. 2013;2:113–6.
Aicher D, Schneider U, Schmied W, Kunihara T, Tochii M, Schäfers HJ. Early results with annular support in reconstruction of the bicuspid aortic valve. J Thorac Cardiovasc Surg. 2013;145:S30–4.
Graeter TP, Aicher D, Langer F, Wendler O, Schäfers HJ. Mid-term results of aortic valve preservation: remodelling vs. reimplantation. Thorac Cardiovasc Surg. 2002;50:21–4.
Aicher D, Langer F, Kissinger A, Lausberg H, Fries R, Schäfers HJ. Valvesparing aortic root replacement in bicuspid aortic valves: a reasonable option? J Thorac Cardiovasc Surg. 2004;128:662–8.
Schäfers HJ, Fries R, Langer F, Nikoloudakis N, Graeter T, Grundmann U. Valve-preserving replacement of the ascending aorta: remodeling versus reimplantation. J Thorac Cardiovasc Surg. 1998;116:990–6.
Aicher D, Langer F, Adam O, Tscholl D, Lausberg H, Schäfers HJ. Cusp repair in aortic valve reconstruction: does the technique affect stability? J Thorac Cardiovasc Surg. 2007;134:1533–8.
David TE, Feindel CM, Webb GD, Colman JM, Armstrong S, Maganti M. Long-term results of aortic valve-sparing operations for aortic root aneurysm. J Thorac Cardiovasc Surg. 2006;132:347–54.
David TE, Armstrong S, Maganti M, Colman J, Bradley TJ. Long-term results of aortic valve-sparing operations in patients with Marfan syndrome. J Thorac Cardiovasc Surg. 2009;138:859–64.
David TE, Feindel CM, David CM, Manlhiot C. A quarter of a century of experience with aortic valve-sparing operations. J Thorac Cardiovasc Surg. 2014;148:872–99.
Boodhwani M, de Kerchove L, Watremez C, et al. Assessment and repair of aortic valve cusp prolapse: implications for valve-sparing procedures. J Thorac Cardiovasc Surg. 2011;141:917–25.
Anderson RH. Clinical anatomy of the aortic root. Heart. 2000;84:670–3.
Miyahara S, Omura A, Sakamoto T, et al. Impact of postoperative cusp configuration on midterm durability after aortic root reimplantation. J Heart Valve Dis. 2013;22:509–16.
Rankin JS, Gaca JG. Techniques of aortic valve repair. Innovations (Phila). 2011;6:348–54.
Kunihara T, Arimura S, Sata F, Giebels C, Schneider U, Schäfers HJ. Aortic annulus does not dilate over time after aortic root remodeling with or without annuloplasty. J Thorac Cardiovasc Surg. 2018;155:885–94 e3.
Kunihara T, Neumann N, Kriechbaum SD, Nomura R, Schäfers HJ. Long-term outcome of aortic root remodeling for patients with and without acute aortic dissection. Circ J. 2017;81:1824–31.
Marom G, Halevi R, Haj-Ali R, Rosenfeld M, Schäfers HJ, Raanani E. Numerical model of the aortic root and valve: optimization of graft size and sinotubular junction to annulus ratio. J Thorac Cardiovasc Surg. 2013;146:1227–31.
Schneider U, Aicher D, Miura Y, Schäfers HJ. Suture annuloplasty in aortic valve repair. Ann Thorac Surg. 2016;101:783–5.
Lansac E, Di Centa I, Sleilaty G, et al. Remodeling root repair with an external aortic ring annuloplasty. J Thorac Cardiovasc Surg. 2017;153:1033–42.
De Paulis R, Scaffa R, Nardella S, et al. Use of the Valsalva graft and longterm follow-up. J Thorac Cardiovasc Surg. 2010;140:S23–7.
Bethea BT, Fitton TP, Alejo DE, et al. Results of aortic valve-sparing operations: experience with remodeling and reimplantation procedures in 65 patients. Ann Thorac Surg. 2004;78:767–72.
Kunihara T, Aicher D, Rodionycheva S, et al. Preoperative aortic root geometry and postoperative cusp configuration primarily determine long-term outcome after valve-preserving aortic root repair. J Thorac Cardiovasc Surg. 2012;143:1389–95.
Aicher D, Kunihara T, Abou Issa O, Brittner B, Graber S, Schäfers HJ. Valve configuration determines long-term results after repair of the bicuspid aortic valve. Circulation. 2011;123:178–85.
Schneider U, Hofmann C, Aicher D, Takahashi H, Miura Y, Schäfers HJ. Suture annuloplasty significantly improves the durability of bicuspid aortic valve repair. Ann Thorac Surg. 2017;103:504–10.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
This study was approved by the local ethics committee. Informed consent was waived for data analysis under anonymized form.
Conflict of interest
The authors declare that they have no conflicts of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Miyahara, S., Karliova, I., Giebels, C. et al. Aortic root remodeling in bicuspid and tricuspid aortic valves—long-term results. Indian J Thorac Cardiovasc Surg 36 (Suppl 1), 81–87 (2020). https://doi.org/10.1007/s12055-019-00798-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12055-019-00798-y