P378. Valve-sparing aortic root replacement (David procedure) for the treatment of sinus of Valsalva aneurysm combined with aortic regurgitation

Sheraton Times Square 

Objective:
Aortic regurgitation (AR) is a common coexisting anomaly, present in about one-third of ruptured or unruptured sinus of Valsalva aneurysms (SVA), which is related to the asymmetrical aortectasis of the aneurysm's origin, dilation of the corresponding annulus, and prolapse of the corresponding cusp. Simple cusp repair may not lead to a satisfactory long-term outcome due to the continuous dilation of the affected sinus and corresponding annulus. Therefore, aortic valve replacement may be necessary. Our aim was to characterize an alternative surgical strategy for SVA with AR.

Methods: From July 2016 to Mar 2023, 51 patients of SVA underwent surgical repair in our center, of whom 16 patients (31.4%) were associated with AR (2+-4+). All 16 patients underwent reimplantation valve-sparing aortic root replacement (VSR) for the repair of SVA and AR. In 7 cases, the sac of SVA was transected, through which the aorta was dissected down to the level below the annulus. Part of the SVA wall was retained and sutured to the tubular Dacron graft along with the remaining aortic wall. In the other 9 cases, the aorta was dissected to the level just above the sac of SVA and the sac was kept intact. The interrupted horizontal mattress sutures at the site of SVA were passed from inside the left ventricular outflow tract immediately below the aortic valve, through the sac of SVA, to outside the sac of SVA. And SVA was closed when the graft was attached to the annulus by tying the horizontal mattress sutures. Abnormalities of cusp were corrected by multiple techniques, until all cusps located at the same level with a coaptaion height >3-5mm. Coexisting VSDs were repaired using a Dacron patch through an additional transverse incision of the pulmonary artery.

Results: No aortic valve replacement was performed. The median graft size was 26 (24-28) mm. The cardiopulmonary bypass and cross-clamping time were 121.4±15.4 and 97.6±12.3 mins. There were no in-hospital deaths. At discharge, residual AR of 1+ was present in 5 patients, while no AR was in the other 11 patients. Fourteen patients were followed-up for 6-87 months, and the freedom from AR >2+ was 100%.

Conclusions: VSR combined with cusp repair for SVA with AR can simultaneously correct the aortectasis of the sinus, dilatation of the annulus, and prolapse of the cusp. This surgical approach indicates excellent short-term outcomes and mid-term durability.

Authors
Tianxiang Gu (1), Enyi Shi (1)
Institutions
(1) 1st Hospital, China Medical University, Shenyang, Liaoning

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