Objective

Valve sparing aortic root replacement (VSRR) is performed by either the remodelling or reimplantation technique. There is suggestion that the aortic annulus may dilate following remodelling of the root and lead to aortic regurgitation (AR), however, results from high volume aortic centres have demonstrated freedom from AR for the remodelling technique of 93.2% at 10 years. Our aim was to assess early and late outcomes in VSRR using the remodelling technique with a consistent operative team.

Methods

Prospective data on patients undergoing elective or urgent VSRR between 2005 and 2014 was collected. In each case the remodeling technique was used and a consistent surgical and anaesthetic approach was maintained. Patients undergoing emergency surgery for acute type A aortic dissection were excluded. Patients were followed up at 8 weeks, 6 months and then annually.

Results

Fifty-seven patients underwent VSRR. 70% had connective tissue disorder. Median age was 56 years and 85% were men. 32% had preoperative mild AR and 5% had moderate AR. Median annulus size was 25mm and all were tricuspid aortic valves. There were no deaths or perioperative strokes and no resternotomy for bleeding; haemofiltration or vascular complications. Median ICU and hospital stay was 1 day and 6 days respectively. Freedom from AR was 90% at 7 years and no patients has required re-operation.

Conclusion

We have demonstrated excellent early and long term outcomes in patients undergoing VSRR using the remodelling technique. Our data supports the continued use of this technique, especially in patients with annular size of ≤ 25mm.