Objective To evaluate outcomes of aortic valve-sparing operations in patients with aortic root aneurysms (ARA) combined with aortic insufficiency (AI)

Methods Since March 2006, in our clinic 264 patients with ascending aortic aneurysms were operated on. 140 patients had ARA combined with aortic valve (AV) disease. 50 patients underwent aortic valve-sparing surgery. We performed 49 Tirone David I (TD-I) and 1 Yacoub procedures. Additional procedures were hemiarch repair (n = 1), mitral valve repair (n = 9) and CABG (n = 6). We assessed hospital and long-term results of aortic valve-sparing operations.

Results Total hospital (30-day) mortality was 4% (n = 2). 2(4%) patients required reoperation due to post-operative bleeding. Echocardiography showed none or trivial AI in 38%, mild AI in 54% and moderate AI in 8%. We revealed positive correlation between residual AI and size of aortic annulus, previous AI grade, and size of aortic prosthesis (optimal result in linear aortic graft size 3–5 mm exceeding aortic annulus size). Follow-up was 60% completed. Late mortality was 2% (1 patient). Echocardiography revealed none or trivial AI in 53%, mild AI in 20%, moderate AI in 17% and severe AI in 10% (3 patients). One patient required reoperation 3 years after TD-I operation, the AV replacement with mechanical prosthesis was performed. Another two patients with severe AI are under close surveillance due to normal LV size and NYHA class 1–2. We revealed positive correlation between late AI and residual AI grade, and aortic leaflets coaptation point (optimal result in cases with location of coaptation point at the aortic annulus level or 1–2 mm upper).

Conclusions TD-1 aortic valve-sparing reimplantation is optimal method of treatment in patients with ARA, AI and unaltered AV leaflets. Concordance of linear aortic graft size 3–5 mm exceeding aortic annulus and positioning of AV leaflets coaptation point at the level of aortic annulus or 1–2 mm upper are precursors of good result of valve-sparing operation.