099LONG-TERM RESULTS OF AORTIC VALVE-SPARING OPERATIONS IN PATIENTS WITH AORTIC VALVE INSUFFICIENCY AND AORTIC ROOT ANEURYSM

Objectives: The David technique may provide an alternative to conduit implantation in patients with aneurysm of the ascending aorta and aortic valve insufficiency. Methods: From 1991 to 2012, the David technique was performed in 234 consecutive patients in our department. The mean patient age was 58 ± 14 years; 66 (28%) were female and 168 (72%) were male. A modification of the David technique was performed by creating a pseudo-sinus in 43 patients (18%) and in 108 patients (46%) by creating a neo-sinus. The mean follow-up was 6 ± 4 years. Results: There were six in-hospital (2.6%) and 26 late deaths (2.2%/patient-year). Cardiovascular events were the cause of death in three patients. The Kaplan-Meier estimate for 10-year survival was 74%. Four patients had perioperative neurologic events, and only five during follow-up (0.42%/patient-year). Nine patients (0.76%/patient-year) required aortic valve replacement, one because of combined aortic valve stenosis and insufficiency and eight because of severe aortic valve insufficiency as a result of leaflet prolapse (n = 3), leaflet perforation (n = 1), abridgement of the right coronary leaflet (n = 1), and endocarditis (n = 3). Three cases of bleeding were observed (0.25%/patient-year). Freedom from reoperation and aortic valve insufficiency >2° was 87% at 10 years. Conclusions: Aortic valve sparing to treat patients with ascending aortic aneurysm with aortic valve insufficiency is a durable procedure. Aortic valve function remains stable for many years. The long-term results are an encouragement to perform this well established technique.