Long-term Outcomes Following Valve-Sparing Root Replacement with Concomitant Mitral Repair.

OBJECTIVES: To examine the late outcomes of valve-sparing root replacement and concomitant mitral valve repair in patients who have been followed prospectively for more than two decades.

METHODS: From 1992 to 2020, 54 consecutive patients (mean age 47±16 years; 80% male) underwent valve-sparing root replacement (45 reimplantation; 9 remodeling) with concomitant repair of the mitral valve. Patients were followed prospectively for a median (IQR) of 9 [3 - 14] years.

RESULTS: No patient suffered a perioperative death or stroke. There were 3 late deaths and the 15-year overall survival [95% CI] was 96.0% [74.8%, 99.4%], similar to the age- and sex-matched population. Over the follow-up period, 6 patients had reoperation of the aortic valve and 3 on the mitral valve. Of those, 2 had reoperation on both aortic and mitral valves for a total of 7 reoperations in this cohort. The cumulative proportion [95% CI] of reoperation at 10 years of either or both valves were as follows: aortic valve 11.4% [3.9% - 33.3%]; mitral valve 4.2% [0.6% - 28.4%]; both valves 11.4% [3.9% - 33.3%]. The estimated probability of developing moderate/severe aortic insufficiency at 15 years was 18.5% [9.0%-34.2]. On last echocardiographic follow-up, none of the patients had developed moderate/severe mitral regurgitation.

CONCLUSION: In this single center series of concomitant valve-sparing root replacement and mitral valve repair, we observed excellent clinical outcomes with a low risk of death or valve-related complications. Continued surveillance of late valve function is necessary.