TY - JOUR AU - Borowski, Andreas AU - Minol, Jan-Philipp AU - Kröpil, Patric AU - Rellecke, Philipp AU - Mehdiani, Arash AU - Dalyanoglu, Hannan PY - 2019/06/03 Y2 - 2024/03/28 TI - Relevance of Leaflet Prolapse to the Indication Policy for Aortic Valve-Sparing Root Replacement JF - The Heart Surgery Forum JA - HSF VL - 22 IS - 3 SE - DO - 10.1532/hsf.2201 UR - https://journal.hsforum.com/index.php/HSF/article/view/2201 SP - E241-E246 AB - <p class="p1"><span class="s1"><strong>Background:</strong> 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.</span></p><p class="p1"><span class="s1"><strong>Materials and Methods:</strong> 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.</span></p><p class="p1"><span class="s1"><strong>Results:</strong> Group B showed a higher mean AR grade <br> (<em>P</em> = .007), a higher mean diameter at the level of the aortic annulus (<em>P</em> = .038), AVJ (<em>P</em> = .037), and aortic sinus (<em>P</em> &lt;.001) and a higher sinus dilatation index (existing-to-predicted diameter ratio) (<em>P</em> &lt;.001) than group A. The sinus of Valsalva displayed the best predictive value regarding a plicature-indicating prolapse (<em>P</em> &lt;.001; 95% confidence interval [CI]: 0.809-1.013). A diameter &gt;40 mm was accompanied by an odds ratio (OR) of 24.6 (95% CI: 1.29-496.02). </span></p><p class="p1"><span class="s1">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.</span></p><p class="p1"><span class="s1"><strong>Conclusion:</strong> 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.</span></p> ER -