Sven Peterss1, Rohan Bhandari2, John A Rizzo3, Hai Fang4, Gregory A Kuzmik2, Bulat A Ziganshin5, John A Elefteriades6. 1. Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut; Department of Cardiac Surgery, University Hospital Munich, Ludwig Maximilian University, Munich, Germany. 2. Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut. 3. Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut; Departments of Economics and Preventive Medicine, Stony Brook University, Stony Brook, New York. 4. China Center for Health Development Studies, Peking University, Beijing, China. 5. Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut; Department of Surgical Diseases 2, Kazan State Medical University, Kazan, Russia. 6. Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut. Electronic address: john.elefteriades@yale.edu.
Abstract
BACKGROUND: Leaving native aortic tissue in situ in root-sparing ascending aortic replacement raises concern regarding potential later need for root reoperation or for the potential occurrence of localized dissections or rupture in the residual root. The purpose of this study was to evaluate the natural growth of the aortic root after root-sparing aortic replacement. METHODS: In all, 102 consecutive patients (mean age 61.8 ± 12.5 years; 60% male) who had undergone root-sparing aortic replacement had sufficient retrievable information regarding their aortic root diameter at postoperative baseline and follow-up imaging by computed tomography or echocardiography. The annual growth rate was evaluated and also compared according to the influence of valve morphology and concomitant aortic valve replacement. Furthermore, the years of natural history that would require for root enlargement to meet a 50 mm threshold of the root diameter were calculated. RESULTS: The estimated growth rate of the aortic root after root-sparing aortic replacement is between 0.27 and 0.51 mm per year (mean 0.41 mm, varying according to the underlying diameter) and therefore fivefold less than other aortic regions. Accordingly, a root aneurysm indicating reoperation would not be expected for 29.1 years on average. Only patients with a diameter of 45 mm or more are at risk for reoperation, and not until at least after 10.4 years have passed. Neither the valve morphology (p = 0.62) nor concomitant aortic valve replacement (p = 0.86) influenced rate of root dilation. CONCLUSIONS: In nonsyndromic patients, the aortic root is the slowest growing portion of the thoracic aorta. Leaving the native root, as in root-sparing ascending aortic replacement, is a safe approach regarding secondary root intervention for aortic root diameters of 45 mm or less.
BACKGROUND: Leaving native aortic tissue in situ in root-sparing ascending aortic replacement raises concern regarding potential later need for root reoperation or for the potential occurrence of localized dissections or rupture in the residual root. The purpose of this study was to evaluate the natural growth of the aortic root after root-sparing aortic replacement. METHODS: In all, 102 consecutive patients (mean age 61.8 ± 12.5 years; 60% male) who had undergone root-sparing aortic replacement had sufficient retrievable information regarding their aortic root diameter at postoperative baseline and follow-up imaging by computed tomography or echocardiography. The annual growth rate was evaluated and also compared according to the influence of valve morphology and concomitant aortic valve replacement. Furthermore, the years of natural history that would require for root enlargement to meet a 50 mm threshold of the root diameter were calculated. RESULTS: The estimated growth rate of the aortic root after root-sparing aortic replacement is between 0.27 and 0.51 mm per year (mean 0.41 mm, varying according to the underlying diameter) and therefore fivefold less than other aortic regions. Accordingly, a root aneurysm indicating reoperation would not be expected for 29.1 years on average. Only patients with a diameter of 45 mm or more are at risk for reoperation, and not until at least after 10.4 years have passed. Neither the valve morphology (p = 0.62) nor concomitant aortic valve replacement (p = 0.86) influenced rate of root dilation. CONCLUSIONS: In nonsyndromic patients, the aortic root is the slowest growing portion of the thoracic aorta. Leaving the native root, as in root-sparing ascending aortic replacement, is a safe approach regarding secondary root intervention for aortic root diameters of 45 mm or less.