Mid- and Long-term Follow up Comparing Straight versus Sinus Prosthesis for Reimplantation of the Aortic Valve

Objectives: Reimplantation of the aortic valve (RAV) is an established operation for patients with aortic annulus dilation and aortic regurgitation. However, the effect of sinuses of Valsalva is missing in straight aortic prosthesis. The aim of this study is to compare mid- and long-term outcome using a straight aortic or sinus prosthesis.

Methods: In the past 22 years a total of 267 consecutive patients underwent RAV at our department. Patients were followed on regular basis in our out-patient unit and echocardiography was performed. Retrospectively, we evaluated aortic valve morphology and function in respect to transvalvular gradients and recurrent regurgitation. The median follow-up was 4.6 years, ranging from 0.1 to 22.1 years.

Results: The median age was 51 years (range 13 - 79 years). Patient underwent RAV as an elective, urgent, emergent or salvage operation in 76.4%, 5.2%, 17.2% or 1.1%, respectively. Forty-three patients had Marfan-syndrome, 38 had Type-A dissection, 67 had bicuspid aortic morphology and 122 had moderate or severe aortic regurgitation prior to the operation. In 32 patients concomitant CABG operation was performed due to coronary artery disease. Thirty-day mortality was 3.4% (n = 9). Seven of the 9 patients had Type-A dissection. Straight aortic prosthesis was used in 159 patients and 108 received sinus prosthesis. Sixteen patients (10%) in the straight prosthesis group needed reoperation, whereas only 1 patient (0.9%) in the sinus prosthesis group had a second operation. Log-rank test showed significant better overall survival (p = 0.035) using sinus prosthesis. Between groups no significant difference regarding freedom from aortic regurgitation >2 (p = 0.348) could be detected. However, there seems to be a trend for better performance in sinus prosthesis beyond 3 years postoperatively.

Conclusion: Patients receiving sinus prosthesis for RAV showed a greater freedom from reoperation and had a survival benefit. Although, log-rank test could not detect significant differences between groups in terms of new onset of moderate or severe aortic regurgitation, there seems to be a trend of improved long-term aortic valve performance using sinus prosthesis, because of better flow pattern with reduced stress on the leaflets.