German Aortic Root Repair Registry - Insights from the First 400 Consecutive Patients.

Abstract

BACKGROUND\nThe objective was to provide initial data from our prospective valve-sparing aortic root replacement (V-SARR) registry and reasons for conversion to prosthetic replacement (AVR).\n\n\nMETHODS\nSix centers established an intention-to-treat-design V-SARR-registry (German Aortic Root Repair Registry, GEARR, first-patient-in 10/2016) with main inclusion criterion scheduled for V-SARR as Plan A . Clinical information, operative details, intraoperative valve/root measurements and clinical/TTE follow-up-data are documented.\n\n\nRESULTS\nOf a total of n=449, we report data on n=401 patients (81% male, mean age 51±14y). N=350 underwent V-SARR as scheduled (Group A, David -variants I 55%, III 2%, IV 13%, V 24%, V- Stanford 2%, Yacoub-Remodeling 2%), n=51 were converted to AVR (Group B). Median follow-up was 11 months (0-2.6y), cumulative follow-up 279 patient-years. In Group B there were less connective tissue disorders (6vs16%), fewer patients had LVEF>50% (60%vs90%), more had bicuspid aortic valves (BAV,45%vs28%), fewer patients had preoperative non/trace AR (2%vs20%). Fewer individuals in Group B had rare types of BAV (fused N/L, R/N, 10%vs30%) and more had unbalanced roots (56%vs40%). Immediate-postoperative AR was none/trace in 79%, and mild in 20%. At 30 days the dpmean was 7±5mmHg. None of the patients died in hospital, two strokes occurred. One patient needed early AVR as re-do surgery.\n\n\nCONCLUSIONS\nMain factors causing surgeons to convert a planned V-SARR to AVR include asymmetry of aortic valve/root, severity of AR, safety-reasons (LVEF), and BAV, but not rare types of BAV. GEARR will help us identify the impact on long-term outcomes of pre- and postoperative valvular anatomy and various V-SARR types.