Relevance of Leaflet Prolapse to the Indication Policy for Aortic Valve-Sparing Root Replacement

  • Andreas Borowski Department of Cardiovascular Surgery, University Hospital, Dusseldorf, Germany
  • Jan-Philipp Minol Department of Cardiovascular Surgery, University Hospital, Dusseldorf, Germany
  • Patric Kröpil Department of Radiology, University Hospital, Dusseldorf, Germany
  • Philipp Rellecke Department of Cardiovascular Surgery, University Hospital, Dusseldorf, Germany
  • Arash Mehdiani Department of Cardiovascular Surgery, University Hospital, Dusseldorf, Germany
  • Hannan Dalyanoglu Department of Cardiovascular Surgery, University Hospital, Dusseldorf, Germany

Abstract

Background: In aortic root replacement, “preexisting” or “induced” aortic leaflet prolapse is related to advanced aortic root pathology and can indicate valve repair. Efforts should be made to perform root replacement before leaflet prolapse is in its maximum extent.

Materials and Methods: Thirty-nine patients with chronic aortic root dilatation and aortic valve regurgitation (AR) underwent a reimplantation procedure. Contrary to 32 of the 39 patients (group A), 7 of the 39 patients (group B) underwent cusp plication for prolapse. For both groups, data related to the diameter at the level of maximal tubular extension, sinotubular junction, sinus of Valsalva, aorto-ventricular junction (AVJ), and aortic annulus were obtained from preoperative computed tomography scans and analyzed comparatively.

Results: Group B showed a higher mean AR grade
(P = .007), a higher mean diameter at the level of the aortic annulus (P = .038), AVJ (P = .037), and aortic sinus (P <.001) and a higher sinus dilatation index (existing-to-predicted diameter ratio) (P <.001) than group A. The sinus of Valsalva displayed the best predictive value regarding a plicature-indicating prolapse (P <.001; 95% confidence interval [CI]: 0.809-1.013). A diameter >40 mm was accompanied by an odds ratio (OR) of 24.6 (95% CI: 1.29-496.02).

During the follow-up period of 29.0 ± 18.4 months (range: 6-62 months), 1 patient (group A) required reoperation 5 years postoperatively for progressive AR.

Conclusion: The sinus of Valsalva diameter seems to have the greatest prognostic value for the development of prolapse. Our data suggest that root repair should be considered earlier in time before leaflet prolapse is complete, which most likely occurs when root dilatation becomes an aneurysm.

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Published
2019-06-03
Section
Articles