Replacement of the ascending aorta with reduction of the diameter of the sinotubular junction to treat aortic insufficiency in patients with ascending aortic aneurysm.

OBJECTIVE: Ascending aortic aneurysm often causes dilation of the sinotubular junction with consequent aortic insufficiency despite normal aortic cusps.

METHODS: Replacement of the ascending aorta with reduction of the diameter of the sinotubular junction to correct aortic insufficiency was performed in 103 consecutive patients. Twenty-nine also needed repair of cusp prolapse. The patients' mean age was 65 +/- 12 years and all had ascending aortic aneurysm; 63 also had arch aneurysm and 21 had aneurysm of the entire aorta. The aortic insufficiency was graded as moderate in 54 patients and severe in 49. Patients were followed up prospectively and had echocardiographic studies annually. The mean follow-up was 5.7 +/- 3.4 years.

RESULTS: There were 2 operative and 30 late deaths. Cardiovascular events were the cause of death in 19 patients. Arch aneurysm and age were the only predictors of late death. Overall survival at 10 years was 54% +/- 7%. Seven patients had moderate and 1 had severe aortic insufficiency. The freedom from moderate or severe aortic insufficiency at 10 years was 80% +/- 7% and from severe aortic insufficiency, 98% +/- 1%. Two patients required aortic valve replacement, 1 because of severe aortic insufficiency and 1 for endocarditis. The freedom from aortic valve replacement at 10 years was 97% +/- 1%. At the latest follow-up, 98% of the patients were in functional class I or II.

CONCLUSIONS: Reduction in the diameter of the sinotubular junction restores aortic valve competence in patients with ascending aortic aneurysm and aortic insufficiency with normal aortic cusps. Late survival of these patients is suboptimal because they often have extensive aneurysmal disease.