Sinus of Valsalva aneurysms with concomitant aortic insufficiency: how should the aortic valve be managed?

OBJECTIVES: Sinus of Valsalva aneurysms (SVAs) are rare and are often complicated by aortic insufficiency (AI). Treating AI is important for achieving good long-term results in patients with SVA. Here, we have summarized our experience with the surgical management of patients with SVA with concomitant AI.

METHODS: Patients who were diagnosed with SVA and underwent surgical treatment between January 2008 and May 2016 were included. Clinical characteristics, including age, gender, SVA anatomy and concurrent anomalies, were analysed. The surgical strategies, intraoperative results and early and late outcomes were evaluated.

RESULTS: A total of 178 patients (age 37.4 ± 13.1 years, 114 men) were identified. Eighty-seven (48.9%) patients had at least 2+ AI preoperatively. Patients with AI had a significant higher incidence of right coronary SVA with concomitant ventricular septal defects (80.5% vs 54.9%, P < 0.001). Concurrent aortic valve surgery was performed in 70 patients with 63 valve replacements and 7 valve repairs. The other 17 patients underwent SVA repair only. The mean follow-up time was 44.4 ± 33.8 months. During the follow-up, no patients who underwent valve replacement experienced perivalvular leakage, whereas 7 patients who underwent aortic valve repair had trivial-to-mild AI and 3 of the 17 patients who underwent SVA repair only presented with moderate AI.

CONCLUSIONS: Various surgical techniques can be utilized to manage concomitant AI without compromising short-term outcomes. Valve replacement yields good long-term results. According to our experience, valve repair, especially valve-sparing procedures performed by experienced surgeons, could be an acceptable option when managing concomitant AI in young patients.