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Original research
Early and long-term outcomes of conventional and valve-sparing aortic root replacement
  1. Marjan Jahangiri1,
  2. Krishna Mani1,
  3. Metesh Acharya1,
  4. Rajdeep Bilkhu1,
  5. Paul Quinton2,
  6. Frank Schroeder2,
  7. Robert Morgan3,
  8. Mark Edsell2
  1. 1Cardiac Surgery, St George's Hospital, London, UK
  2. 2Cardiac Anaesthesia, St George's Hospital, London, UK
  3. 3Radiology, St George's Hospital, London, UK
  1. Correspondence to Professor Marjan Jahangiri, Cardiac Surgery, St George's Hospital, London SW17 0QT, UK; marjan.jahangiri{at}stgeorges.nhs.uk

Abstract

Objective To determine the early and long-term outcomes of conventional aortic root (ARR) and valve-sparing root replacement (VSRR) using a standard perioperative and operative approach.

Methods We present prospectively collected data of 609 consecutive patients undergoing elective and urgent aortic root surgery (470 ARR, 139 VSRR) between 2006 and 2020. Primary outcomes were operative mortality and incidence of postoperative complications. Secondary outcomes were long-term survival and requirement for reintervention. Median follow-up was 7.6 years (range 0.5–14.5).

Results 189 patients (31%) had bicuspid aortic valves and 17 (6.9%) underwent redo procedures. Median cross-clamp time was 88 (range 54–208) min with cardiopulmonary bypass of 108 (range 75–296) min. In-hospital mortality was 10 (1.6%), with transient ischaemic attacks/strokes occurring in 1.1%. In-hospital mortality for VSRR was 0.7%. 12 patients (2.0%) required a resternotomy for bleeding and 14 (2.3%) received haemofiltration. Intensive care unit and hospital stay were 1.7 and 7.0 days, respectively. During follow-up, redo surgery for native aortic valve replacement was required in 1.4% of the VSRR group. Overall survival was 95.1% at 3 years, 93.1% at 5 years, 91.2% at 7 years and 88.6% at 10 years.

Conclusions ARR and VSRR can be performed with low mortality and morbidity as well as a low rate of reintervention during the period of long-term follow-up, if performed by an experienced team with a consistent perioperative approach. This series provides contemporary evidence to balance the risks of aortic aneurysms and their rupture at diameters of <5.5 cm against the risks and benefits of surgery.

  • Aortic Aneurysm
  • AORTIC VALVE DISEASE
  • Aortic Valve Insufficiency
  • Aortic Valve Stenosis

Data availability statement

No data are available.

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Footnotes

  • Twitter @rsbilkhu, @markedsell

  • Contributors MJ has been the primary surgeon in charge of the patients, designed the study, cumulated the database, wrote the original drafts and revised subsequent versions. KM has cumulated and cleaned the database and assisted in writing the original and subsequent drafts. MA has assisted in writing the original and subsequent drafts. RB has assisted in writing the original and subsequent drafts. PQ has contributed significantly to the preoperative and postoperative phases of care. In addition, he has reviewed the data, reviewed several versions of the manuscript and finalised the draft. FS has contributed significantly to the preoperative and postoperative phases of care. In addition, he has reviewed the data, reviewed several versions of the manuscript and finalised the draft. RM has contributed significantly to the preoperative and postoperative phases of care. In addition, he has reviewed the data, reviewed several versions of the manuscript and finalised the draft. ME has contributed significantly to the preoperative and postoperative phases of care. In addition, he has reviewed the data, reviewed several versions of the manuscript and finalised the draft. MJ is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests MJ has received educational grants from Edwards Lifesciences. The other authors have no conflicts of interest to declare.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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