• Aortic Diseases

A key consideration in optimal timing of intervention in patients with aortic root disease, with or without aortic valve involvement, has been the need for a combined graft and prosthetic aortic valve in nearly all patients. The long-term risks of a prosthetic valve, including valve degeneration with a bioprosthetic valve or anticoagulation with a mechanical valve, tilted the balance towards intervention late in the disease course. Surgical techniques to replace the aortic root replacement while maintaining an intact native aortic valve have been proposed but are not widely available, in part due to lack of outcome data.

In this issue of Heart, Jahangiri and colleagues1 report their experiencefor 609 consecutive patients (mean age 60 years, 74% male, 31% bicuspid aortic valve, 23% connective tissue diseases) who underwent aortic root surgery between 2006 and 2020. Overall operative mortality was 1.6% with a 10 year survival of 88.6%. The surgical approach was conventional composite root and valve replacement in 77%. In the 139 patients undergoing valve-sparing root replacement (VSRR), operative mortality was 0.7%, median hospital length of stay was 6 days, in hospital complications were rare and only 2 patients required re-do surgery at a median follow-up of 7.6 years, all of which compare favourably with conventional combined root and valve replacement (figure 1).

In the accompanying editorial, David2 points out …