Background: Aortic valve resuspension for ascending aortic aneurysm repair is associated with removal of the sinus of Valsalva. This may cause changes in leaflet motion and thus impact on long term durability. We studied the opening and closing characteristics of the aortic valve leaflets after reimplantation by the technique described by T. David and a modification to create a “neosinus” compared to an age matched control group.

Methods: Between September 1995 and May 2002, 25 patients underwent aortic root reconstruction as described by Tirone David (Group A). In 24 patients the technique was modified by shaping a “neosinus” (Group B). In both groups the native valve was preserved and suspended inside a tubular prosthesis with reimplantation of the coronary arteries. Transthoracic and transesophageal studies on aortic valve dynamics were performed intraoperatively, before hospital discharge and one year after surgery in all patients and compared to a separate group of 25 matched control individuals (Group C).

Results: There was two perioperative deaths due to myocardial infarction and mesenterial emboli. Two patients suffered a stroke. Twentysix patients were followed up 12 months postoperatively. Twentytwo out of 26 patients were in NYHA functional class I, 2 patients in class II and the remaining 2 in class III. Three patients died in the postoperative period. Six patients had trivial AR, 4 had mild and 1 had moderate regurgitation. There were no thromboembolic events during follow up. The mean transvalvular gradient was 3.5 ± 2.2 mmHg. Valve opening velocity was 61.3 ± 20.1 cm/s in Group A, 46.3 ± 8 cm/s in Group B, and 29.2 ± 9.8 cm/s in Group C (Group A vs. B p = 0.003, A vs. Group C p < 0.001, B vs. C p < 0.001). Closing velocity was accelerated to 57.5 ± 23 cm/s in Group A and 43.8 ± 7 cm/s in Group B compared to 23.6 ± 7 cm/s in Group C (A vs B p = 0.012, A vs C p < 0.001, B vs C p = 0.002). In 7 patients of Group A the leaflets touched the prosthetic wall during systole.

Conclusions: Reimplantation of the natural aortic valve in a prosthetic graft causes abnormally high opening and closing speeds with possibly increased stress. We could prove more physiologic valve dynamics after creation of a sinus bulge compared to the conventional reimplantation technique. Midterm clinical observation however showed favourable valve competence for both types of repair. Long term follow up is necessary to prove whether more physiologic leaflet dynamics lead to improved durability.

Keywords : Aortic root aneurysm, valve sparing operation, aortic root reconstruction