Individualisierte Aortenwurzelrekonstruktion mit selektiven Ersatz der Sinus Valsalvae: Operationstechnik und Langzeitergebnisse

Paul P. Urbanski developed a surgical technique with the aim of improving the various surgical and anatomo-physiological aspects of root reconstruction. In the course of this surgical technique, an individualized replacement of the Sinus Valsalvae with a Dacron patch and the reconstruction of the sinutubular junction is performed. This restores the anatomical shape of the aortic root and avoids changes in its geometry, which can lead to the development of iatrogenic aortic regurgitation. The aim of the present study was to determine the long-term results after the valve-preserving aortic root reconstruction developed by Urbanski through individualized replacement of the Valsalvae sinus. The mean follow-up time was 7.1 ± 4.1 years, corresponding to 4725 patient-years. The results are as follows: 339 patients (50.67%) AKI 0, 289 patients (43.19) AKI 1+, 26 patients (3.88%) AKI 2+ and 15 patients (2.42) AKI ≥3 +. The resulting cumulative freedom from AKI ≥ 3+ was 98 ± 1%, 97 ± 1%, and 94 ± 3% at 5 years, 10 years. The cumulative freedom from AKI ≥ 3+ and aortic valve replacement was 97.5%, 95.9%, and 87.9% at 5, 10, and 15 years, respectively. It also showed a normal life expectancy after reconstructive aortic valve surgery in the elderly and an unchanged chance of survival in a general German population of the same age and sex, despite an acute aortic dissection rate of 15%. For comparison with the literature, we first compared the data from two publications in which the reimplantation technique was described. It turned out that the technique developed by Urbanski produces better long-term results. In order to have a comparison with the remodeling technique, our data were compared to those from Bad Homburg. This showed that our long-term results were equally good. In summary, the valve-preserving aortic root reconstruction developed by Urbanski through individualized replacement of the Valsalvae sinus is a valid option for valve-preserving root replacement with very good long-term results. In combination with the correction of an aortic valve prolapse, aortic valve function can be restored.