Aortic Valve Reconstruction with Leaflet Replacement and Sinotubular Junction Fixation: Early and Midterm Results

Background. Aortic valve reconstruction surgery (AVRS), consisting of aortic leaflet reconstruction with tailored pericardial patches and fixation of the sinotubular junction with properly sized fabric rings, is performed for the treatment of aortic valve diseases. The early and midterm outcomes of AVRS were analyzed.Methods. Between December 2007 and December 2012, 262 patients with isolated aortic valve disease underwent AVRS in one center. Clinical outcomes, effective orifice area, mean gradients, and left ventricular mass index were evaluated yearly.Results. Mean follow-up duration was 36.0 +/- 17.1 months and was complete in 100% of surviving patients. There was no hospital mortality, but there were 3 late deaths (1.1% late mortality). Seven patients (2.7%) required reoperation: 5 because of endocarditis and 2 because of suture disruption of the leaflets. Ten patients (3.8%) experienced neurologic events. Aortic valve regurgitation was absent or trivial in 226 patients (87.3%) and mild in 29 (11.2%), mild to moderate in 3 (1.2%), and moderate to severe in 1 (0.4%). The mean valve gradient and valve orifice index were 10.6 +/- 5.3 mm Hg and 1.3 +/- 0.4 cm(2)/m(2), respectively.Conclusions. The data from the first 5 years after AVRS reveal good clinical and hemodynamic outcomes, suggesting that AVRS is a new alternative technique to the practice of replacement with stented bioprostheses and mechanical prostheses. However, whether the reconstructed aortic valve represents a truly long-term valve remains to be demonstrated. (C) 2014 by The Society of Thoracic Surgeons