Evolution over time of aortic root anatomy after aortic valve reimplantation

Objective

Restoring the anatomic relationships among the aortic root components is important to achieve durable valve competence. We previously analyzed the in vivo anatomy of the aortic root after reimplantation with the Valsalva graft. This study aims to evaluate if the topographic relationship among the neoroot components varies over time.

Methods

Ten patients underwent a reimplantation procedure with the Valsalva graft. Surgical hemoclips were applied as radiopaque markers at the base of the annular knots and at the reimplanted commissures. All patients underwent a cardiac computed tomography scan at discharge (T0) and at follow-up (T1). Aortic root features were measured in both series. The annular dimensions and the distances between the annular hemoclips and the virtual basal ring—as height from the annular plane and as distance from the annular lumen—were measured, and compared at T0 and T1.

Results

The mean follow-up time was 50 ± 4 months. There were no deaths, reoperations, or recurrent aortic regurgitation. Postoperative (T0) versus follow-up (T1) measures showed no significant differences in annular dimensions. The mean heights of polyethylene terephthalate graft basal landmarks and planar distance from virtual basal ring were also not significantly modified over time.

Conclusions

After a mean of 4 years of follow-up, no significant modification of the relationships among aortic root components occurred. The proximal edge of the polyethylene terephthalate graft lies at the ventricular-arterial junction at a slightly different thickness and height along the annular circumference, especially at the level of right sinus and left-right commissure. This feature persists at follow-up.