Objective To assess clinical outcomes of valve-sparing aortic root replacement for patients with aortic root aneurysm.?Methods?From February 2001 to September 2010， sixty patients with aortic root aneurysm underwent valve-sparing aortic root replacement in Fu Wai Hospital. There were 44 male patients and 16 female patients with an average age of 37.2±13.0 years （ranging from 9-64 years）. Fifteen patients had aortic dissection， 10 patients had ascendingaorta aneurysm， 25 patients had Marfan syndrome， and 2 patients had bicuspid aortic valve. Aortic root reconstruction was performed in 53 patients and aortic valve reimplantation was performed in 7 patients. Preoperative and postoperative heart function and degree of aortic insufficiency （AI） were compared.?Results?Valve-sparing aortic root replacement was performed in all patients. There was no in-hospital death or severe postoperative complications in this group. The median duration of mechanical ventilation was 13 hours （ranging from 2 to 1 110 hours） ， while the mean intensive care unit stay was 2.7±2.5 days （ranging from 1 to 18 days） . Postoperative echocardiography showed AI degree was significantly reduced in all the patients. Only three patients had moderate to severe AI， and all the other patients had none or trivial AI. All the patients were followed up for 2-122 （61.5±35.9） months. During follow-up， 4 patients were lost， 9 patients died， and the overall survival rate was 83.9% （47/56）. Two patients underwent aortic valve replacement in the 13 th and 14 th postoperative month respectively because of severe AI. Heart function of 47 patients was significantly improved compared with their preoperative heart function. Thirty-five patients （74.4%）were in New York Heart Association （NYHA） functional classⅠ， and 8 patients （17.0%） were in class II. Forty patients （85.1%）were free from moderate or severe AI.?Conclusion Valve-sparing aortic root replacement has satisfactory long-term outcomes for patients with aortic root aneurysm， and valve-related complication rate is low.
Objective To improve the surgical results of infective endocarditis, the results and methods of aortic root replacement in patients with severe aortic valve infective or prosthetic valve endocarditis were summarized. Methods From Sept.1995 to June 2008, there were 11 patients with severe aortic valve endocarditis treated surgically, included 6 active endocarditis and 5 healed endocarditis. Preoperative arterial blood bacterial culture were positive in 6 patients. Preoperative echocardiography showed all patients had various degree of aortic regurgitation or paraprosthetic leakage, left ventricular endsystolic diameter(LVESD) was 6.0±0.7cm, LVESD was equal or greater than 5.5cm in 7 patients, left ventricular ejection fraction (LVEF) was 47.8%±11.2％, and LVEF was equal or less than 50% in 8 patients. After careful debridement, composite conduit (9 patients) or cryopreserved allograft (2 patients) was used to replace the aortic root. Concomitant procedures were coronary artery bypass grafting in 4 patients, mitral annuloplasty in 3 patients, and ventricular septal defect repair in 1 patient. Results There was one patient died of postoperative cardiac arrest, one patient had Ⅲ° atrioventricular block and pacemaker implanted. Ten patients were followed up, followup time were from 3 months to 13.2 years. During the followup period, one patient had recurrence of endocarditis and died, others survived uneventually. Conclusion Aortic root replacement must be considered in following patients: endocarditis combined with root aneurysm or sinus aneurysm, infectious disease involved in sinus wall or nearby coronary ostia, annulus impairment and severe destructive annulus after debridement. The key points of the surgery are debriding the infectious tissue completely, preventing aortic root bleeding. Although the root replacement is relatively complex, the surgical results could be improved after complete debridement of infectious tissue.