Aortic Valve Sparing Surgery. Results To 9 Years

Introduction and objectives: Clinical practice guidelines recommend, in young patients and experienced centers, aortic valve sparing surgery for the treatment of aortic regurgitation as an alternative to aortic valve replacement. It is a complex surgery, but demanded more frequently. We must consider it as a therapeutic option and explain its results.Methods: Prospective, non randomized, analysis of 138 patients operated on with aortic valve sparing surgery (2011-2019).Results: They presented: mean-age 58.1+14.2 years, 33 (23.9%) women, 9 (6.5%) emerging; EUROSCOREII: 3.35+2.9, EUROSCORE-LOGISTIC: 9.29+7. Valve morphology was: 83 (60.1%)-tricuspid, 44 (31.9%)-bicuspid, 11 (8%)-unicuspid. Procedures performed: (valve-reimplantation [DAVID] + aortic-plasty): 78 (56.5%); (aortic-remodeling [YACOUB] + aortic-plasty): 22 (15.9%); aortic-plasty+supracoronary-tube: 15 (10.9%); aortic-plasty: 23 (16.7%). The 69.36% of aortic leafleats required multiple techniques: (63.5%) central-plication, (10.3%) decalcification and (20.9%) pericardium-plasty.There was reoperation for bleeding 4 (2.9%). Eight (5.8%) patients died in the immediate postoperative period (3.9% of electives).Preoperative aortic regurgitation was: I-II(18.1%), 111(17.4%) and IV( 64.5%). Intra-operative regurgitation grade II persisted in 16 (11.6%) patients, converting to aortic prostheses. The mean follow-up was 44.2+28.6 (median 42.5) months.At 9 years they are free of aortic regurgitation > III: 83.5% (whole-series); 84.6% (aortic-root-treatment [DAVID+YACOUB]) vs. 81.9% (no-aortic-root-treatment) (p=0.4); 88.8% (DAVID), 63.2% (YACOUB), 85.7% (aortic-plasty+supracoronary-tube) and 78.3% (aortic-plasty) (p=0.22); 63.5% (pericardium-plasty) vs. 97.7% (without pericardium-plasty) (p<0.0001). And they are free of re-operation: 88.4% (whole-series); 89.7% (aortic-root-treatment [DAVID+YACOUB]) vs. 85.8% (no-aortic-root-treatment) (p=0.27); 89.5% (DAVID), 93.3% (YACOUB), 92.8% (aortic-plasty+supracoronary-tube) and 78.3% (aortic-plasty) (p=0.24); 71.5% (pericardium-plasty) vs. 100%( without pericardium-plasty) (p<0.0001). At follow-up there were endocarditis in 2 (1.75%) patients, there were no thromboembolic events.Conclusions: The durability of aortic valve sparing surgery is good, without significant differences between different types of techniques; the use of heterologous pericardium is the main cause of reduced durability. (C) 2020 Sociedad Espanola de Cirugia Cardiovascular y Endovascular. Published by Elsevier Espana, S.L.U.