Objective

Simultaneous replacement of the aortic root and arch is a complex surgical procedure and a valve sparing aortic root replacement (VSARR) approach is approach is a technically challenging procedure. We aim to review our results in this challenging class of patients and to compare patients who underwent VSARR with those who underwent valve replacement aortic root replacement (VRARR) with a biological valved conduit.

Methods

Interrogation of a prospectively maintained database to identify all consecutive patients who underwent VSARR or biological VRARR associated with an arch replacement (ArcR). Between 2003 and 2015, 19 patients (median age 61, range 15-78 years) underwent VSARR associated with an ArcR. Median Logistic EuroSCORE (LogES) was 13.3% (range 4.6-31.5%). Comparison group consisted of 36 patients who underwent biological VRARR associated to an ArcR matched by LogES (median 13.7%, range 5.9-28.4%).

Results

Median cardiopulmonary bypass and cross-clamp time were significant higher in the VSARR than in the VRARR group (359 vs. 253 and 267 vs. 175 minutes, respectively, p <0.001) but overall in-hospital mortality was no different (10.5% vs. 8.8%, p: ns). There were no cases of permanent stroke, spinal cord injury or postoperative dialysis in both groups. At a median follow-up of 29 months, among the VSARR patients there was only one case of moderate and no cases of severe aortic regurgitation.

Conclusion

Even if it represents a more technically demanding operation, VSARR can be performed safely even in patients requiring extensive surgery as ArcR with results similar to VRARR. Medium-term results are satisfactory, in particularly regarding the competence of the aortic valve.