Valve Sparing Aortic Root Replacement: long term predictors of outcomes and mortality

IntroductionIn aortic root surgery, Valve Sparing Aortic Root Replacement (VSARR) is an attractive alternative by mitigating the risks inherent to prosthetic valves, however little is known about the variables that impact its performance and durability. We have reviewed our mid to long-term outcomes following VSARR and describe factors that impact patient survival and aortic valve reintervention and insufficiency. MethodsA retrospective review of 284 consecutive patients undergoing VSARR between November 1999 and January 2022 at Austin Health, Melbourne, Australia, was undertaken, with median follow up of 6.43 {+/-} 4.83 years, but up to 22.0 years. ResultsThe median age at intervention was 60.0 years (IQR 48.0-67.0), of which 68 (23.9%) had bicuspid aortic valve (BAV) disease, 27 (9.5%) Marfans disease, 119 (41.9%) severe aortic root dilation (>50mm), and 155 (54.6%) severe aortic insufficiency at the time of intervention. The 30-day mortality was 1.8%, with freedom from mortality of 96.0% (95% CI 92.6-97.8%) at 5 years, 88.2% (95% CI 81.4-92.6%) at 10 years and 78.6% (66.2-86.9%) at 15 years. Freedom from aortic re-intervention was 92.2% (95% CI 87.7-95.2%) at 5 years, 79.8% (95% CI 71.8-85.8%) at 10 years, and 74.1% (63.5-82.0%) at 15 years. Predictors of re-intervention were concomitant leaflet repair (HR 8.13, 95%CI 1.07-61.7) and bicuspid valvulopathy (HR 2.23, 95% CI 1.07-4.68). The freedom from aortic insufficiency was 89.1% (95% CI 83.5-92.9%), 84.9% (95% CI 77.8-89.9%) and 80.7% (71.0-87.4%) at 5-, 10- and 15-years respectively. ConclusionVSARR has excellent long-term outcomes, with low mortality and re-intervention rates. Concomitant Leaflet repair and Bicuspid Aortopathy are the only long-term predictors of re-intervention.