Aortic valve-sparing operation at concomitant aortic root and total aortic arch replacement.

Objective: Sparing aortic valve during combined aortic root replacement (ARR) and total aortic arch replacement (TAR) adds surgical complexity; however, the long-term outcomes are unknown. We examine the safety of aortic valve-sparing during these operations.

Methods: To include patients who were potentially eligible for valve-sparing procedures, aortic stenosis, endocarditis, and previous aortic valve surgery were excluded, leaving 81 patients who underwent ARR and TAR between 2004 and 2021 at 2 major aortic centers. Overall, 34 underwent valve-sparing aortic root replacement (VSRR) and 47 underwent composite valve graft root replacement (CVG). The primary endpoint was uneventful recovery: a composite endpoint describing any patient discharged from the hospital without mortality or any postoperative complications including stroke, re-operation for bleeding, prolonged ventilation, or acute renal failure. Secondary endpoints were long-term survival and cardiovascular reintervention at 12 years.

Results: VSRR was more frequently performed in younger patients with connective tissue disorder (P = 0.006) and less than moderate aortic insufficiency (P = 0.002). VSRR had longer cross-clamp time (243, [200-286] vs. 216, [181-250] minutes, P = 0.032). In-hospital mortality (VSRR: 5.9% vs CVG: 10.6%, P = 0.693) and uneventful recovery (VSRR: 47.1% vs CVG: 44.7%, P = 1.000) were not different. Multivariable Logistic regression showed that VSRR was not associated with the uneventful recovery (OR 1.165, 95% CI [0.356-3.814], P = 0.801). Twelve-year survival (VSRR: 80.8% [63.1-100.0%] vs. CVG: 66.3% [47.9-91.7%]; P = 0.320) and the incidence of reintervention (VSRR: 39.0% [19.0-59.0%] vs. CVG: 39.0% [16.0-61.0%], P = 0.820) were similar between groups.

Conclusions: In appropriately selected patients requiring concomitant ARR and TAR, aortic valve-sparing operation may be performed safely.