Noncoronary Sinus Replacement for Aortic Root Reconstruction

Stanislav Tsvelodub, Doreen Richardt, Sina Stock, Léon M. Putman, Hans-Hinrich Sievers

University of Lübeck, Lübeck, Germany

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – C

Abstract

Objective: We present our experience in the isolated noncoronary sinus (NCS) replacement for aortic root reconstruction.

Methods: Between 1996 and 2017, 28 elective patients with NCS enlargement underwent isolated NCS replacement also combined with aortic valve replacement in 16(57.1%), aortic valve repair in 5(17.8%), mitral valve repair in 1(3.6%), tricuspid valve repair in 1(3.6%), coronary artery bypass grafting in 4(14.3%) and supracoronary ascending aorta replacement in 25(89.3%) patients. Mean age was 59.5±12.1 years (32–78.5 years). 20(71.4%) patients were male. Bicuspid aortic valve was found in 18(64.3%) patients, type 1 L/R in 12(66.6%) patients. All patients presented with aortic root ectasia 43.6±4.7mm (35–56mm) at the level of noncoronary sinus and 25(89.3%) patients with ascending aorta aneurysm 53±7.5mm (39–70mm).

An aortic annulus was measured using Hegar dilator and an appropriately sized straight Dacron prosthesis was chosen. A NCS silhouette was painted with marker on prosthesis corresponding to the measured distance between its nadir and sinotubular junction and was cut into U-shaped skirt. The NCS was excised and a running suture with 5-0 Prolene beginning at the nadir of the sinus and continuing up to the edge of the sinotubular junction in the direction of both commissures was performed.

Results: No intrahospital deaths were observed. An intensive care unit stay lengths was 2.9±1.3 days (2–5 days). 4(14.3%) patients died during mean follow-up period of 3.2±5.1 years. 1(3.6%) patient required reoperation unrelated to NCS replacement. Mean aortic root diameter was significantly reduced to 33.8±3.2mm (28–40mm), p<0.0001. In 12(42.8%) patients with primary competent or repaired aortic valve no insufficiency greater I^o was detected nor did we observe any progression of the aortic root dilatation in all patients.

Conclusions: Presented technique demonstrates its safety and effectiveness referring to aortic valve competence and reduction of the aortic root diameter in a short-term follow-up.