ABSTRACT 97

ENDOSCOPIC ASSESSMENT OF AORTIC ROOT GEOMETRY IN VALVE-SPARING OPERATIONS

Satoshi Ohtsubo, Tsuyoshi Itoh, Kojiro Furukawa, Masafumi Natuaki, Kazuhisa Rikitake, Yukio Okazaki
Saga Medical School, Dept. of Cardiovascular Surgery

In consecutive series of valve-sparing aortic root reconstruction (12 “remodeling”, 3 “reimplantation”), aortic root has been directly observed with perfusion of crystalloid cardioplegia.  Type of aneurysm were classified into two groups, ascending aortic dilatation (group A, n=4), and sinus dilatation (group B, n=11).  Maximum diameter of aneurysm (D), diameter of surgical annuls (Sa), length in cusp free mergin (FM), extent of cusp prolapse, degree of pre and postoperative aortic insufficiency (AI; 0:none ~ trivial, 1:mild, 2:moderate, 3:severe) were compared between groups.  There were no significant differences in preoperative AI, D, and Sa.  However, FM in group B (39.4mm) was significantly longer than group C (30.9mm).  Also, FM at non-coronary (41.2mm) and right coronary cusp (40.4mm) were significantly longer than that at left coronary cusp (36.5mm) in group B, while FM of each cusp was equidistant in group A.  In group B, cusp prolapse was seen at the right in 4 patients, non-coronary in 5 and both right and non-coronary in 3.  Postoperative AI in both groups was significantly reduced to 0.3.  In summary, geometrical changes and prolapse were more remarkable in root aneurysm than in ascending aneurysm.  Valve-sparing in root aneurysm is technically more difficult, however, minor cusp prolapse is not contraindication of valve-sparing.