A Progress Report on Reimplantation of the Aortic Valve

Dr David and colleagues reported the long-term outcomes of aortic valve reimplantation in 465 patients between 1989 and 2018. Clinical and echocardiographic follow-up was available in 98% for a mean duration of 10 ± 6 years.
Mean age was 47 ± 5.1 years, and 78% were men. Etiology of aortic root aneurysm was Marfan syndrome in 164 patients, Loeys–Dietz syndrome in 13, bicuspid aortic valve (BAV) in 67, and type A aortic dissection in 33. AI was moderate or severe in 298. At 20 years, 69.1% of patients were alive and free from aortic valve reoperation, and the cumulative incidences were 6.0% for aortic valve reoperation with death, and 10.2% for developing moderate or severe AI. Distal aortic dissections occurred in 22 patients, predominantly in those with genetic syndromes. The development of postoperative AI increased by time (in years) (hazard ratio, 1.06; 95% confidence interval, >1.02-1.10; P = 0.006). 
This series show the excellent long-term results of AV reimplantation, which, however, is associated with progressive rate of AI over time.  Patients with genetic syndromes have a risk of distal aortic dissections.