The following is the summary of “Impact of aortic valve effective height following valve-sparing root replacement on postoperative insufficiency and reoperation,” published in the December 2022 issue of Thoracic and cardiovascular surgery by Kachroo, et al.

This research examined how different aortic root anatomical features affected the likelihood of post-operative aortic insufficiency and freedom from aortic valve reoperation during valve-sparing root replacement. Between 1995 and 2020, 177 patients had valve-sparing root replacements (163 reimplantations, 14 remodelings). Measurements of the annulus and sinus diameters, the effective height of leaflet coaptation, and aortic insufficiency were taken from pre- and post-operative echocardiograms. We utilized logistic regression to examine risk factors for late post-operative aortic insufficiency graded 2+ or more. In addition, aortic valve reintervention predictors were identified using fine-gray regression analysis.

There were 122 (or 69%) male participants in the study, and their average age was 43 +/- 15 years. As many as 119 (67% of the sample) of the patients were found to have a dysfunction of the connective tissue. At 5 years, it was predicted that 7% of patients would require another aortic valve replacement surgery, and at 10 years, that number would rise to 12%. Valve-sparing root replacement was associated with a lower effective height and a higher risk of late post-operative aortic insufficiency of 2+ or greater (P=.018). The risk of aortic insufficiency graded 2 or higher increased to almost 10% when effective post-operative height dropped below 11 mm. The incidence of late postoperative aortic insufficiency graded as 2+ or greater was positively associated with effective height (odds ratio, 0.53), preoperative annulus diameter (odds ratio, 1.44), and preoperative aortic insufficiency grade (odds ratio, 2.57; 1.45-4.52; P=.001). 

Preoperative annulus diameter (subdistribution hazard ratio, 1.28 [1.03-1.59], P=.027), history of 3+ or greater aortic insufficiency (subdistribution hazard ratio, 4.28 [1.60-11.44], P=.004), and 2+ or greater early post-operative aortic insufficiency (subdistribution hazard ratio, 5.22 [2.29-11.90], (P<.00)1In order to reduce the likelihood of severe post-operative aortic insufficiency and the need for aortic valve reoperation, it may be beneficial to take steps to increase effective height during valve-sparing root replacement.

Source: sciencedirect.com/science/article/pii/S0022522322004068