Objective

The importance of recreating the sinuses of Valsalva (SV) at the time of aortic root replacement (ARR) is controversial. Experimental models suggested the SV can play an important role in determining the dynamics of coronary flow and aortic valve mechanics. The latter feature is of particular concern when a biological prosthesis is implanted. We compare early and mid-term outcomes of two propensity matched cohorts that underwent bio- AAR using either a straight tube or a tube graft with neo-SV.

Methods

Analysis of data from 2 quaternary centers (USA – Europe) identified all bio- AAR over the period 2006-2010. Standard technique was a Bentall procedure; the only operative variable was the bioprosthesis was implanted in either a straight graft or a graft with preformed SV (respectively no-SV and SV groups). End-points were operative and follow-up mortality (primary), and postoperative morbidity (secondary). Cohorts’ analysis was achieved with logistic regression in 1-1 propensity score matching

Results

The bio-ARRs identified were 322. After adjustment there was no difference in operative mortality (p 0.31), 5 year survival (p 0.50) and the only difference in postop morbidity was a higher incidence of atrial fibrillation and revision for bleeding in the SV group (both p 0.01). At 5 years follow there was a trend towards increased reoperation in the SV group (all 7 cases in the no-SV group, p 0.07). The cause of reoperation was valve degeneration in 5 out of 7 cases.

Conclusion

Overall early/mid-term outcomes were similar in the compared cohorts. There was a trend towards an increased reoperation rate with non-SV ARR, which however didn’t reach statistical significance. This is a potentially important finding that should be investigated further with broad multi-institutional studies, to elucidate if on an even larger scale this intriguing trend doesn’t reach statistical significance to support a more rapid deterioration of the aortic bioprosthesis in the non-SV ARR.