Objective We sought to evaluate the efficacy of creating glutaraldehyde-tanned autologous pericardial neosinuses to repair (exclude) sinus of Valsalva aortic root pathology.
Methods Over the last decade (1996-2005), 81 patients (mean age 46 ± 20 years) underwent aortic root repairs involving construction of neoaortic pericardial sinuses as a central feature. Sixty-seven (83%) patients were male. The etiology was congenital in 53% (43), including bicuspid aortic valve (30), ventricular septal defect (6), aortic coarctation (4), and connective tissue disorder in 15% (12), including Marfan's syndrome (9). Fifty-eight patients had an ascending aorta aneurysm and five patients experienced Type I dissection. Sixty-six patients had significant aortic regurgitation (AR) and 24 patients had concomitant AR/AS. Seventy-six patients had an aneurysmal non-coronary sinus; 37 and 25 patients had affected right and left coronary sinuses, respectively. Three patients had sinus ruptures into the right ventricle. Surgical approaches included creation of pericardial neosinuses (NCS: 75, RCS: 38, LCS: 24); AV repair (10 pericardial leaflet extensions, 21 subcommissuroplasties); AV replacement (39); ascending aorta repair (14 Hemashield grafts, 54 Dacron mesh wraps), and concomitant mitral valve and tricuspid repairs in 11 and 4 patients, respectively.
Results There was no early mortality (mean follow-up 23 ± 31 months). There was one death at 6.3 years due to complications following another cardiac operation. Nine patients required reoperation for recurrent AR and aneurysmal sinuses (6), and aortic aneurysms/dissections (3). The remaining patients demonstrated good AR (mean grade 1.3 ± 1.1; 3.2 ± 1.0 preoperatively) and aortic root statuses (mean diameter 34.3 ± 6.0 mm; 46.9 ± 12.3 mm preoperatively).
Conclusions Creating neo-aortic sinuses with autologous pericardium offers a promising simple approach to repair sinus-related pathology solely or as adjunctive surgical intervention for multi-level disease in the aortic root and ascending aorta.
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