Surgery for sinus of Valsalva aneurysm: 33-year of a single center experience

Background Sinus of Valsalva aneurysm (SVA) is a rare anomaly and few large or long-term series are well established. This study was designed to review 33-year surgical experience of SVA in one center. Methods From August 1980 to December 2013, patients with SVA underwent surgical repair were retrospectively studied. Results A total of 160 patients were identified with mean age of (30 12) years and 112 (70%) of them were males. The right coronary sinus origin of SVA was found in 108 patients (67.5%), the non-coronary sinus in 51 patients (31.9%), and the left coronary sinus in one patient (0.6%). The rupture of 3VA into the right ventricle was identified in 89 (55.6%) cases, the right atrium in 61(38.1%), the left ventricle in 2 (1.3%) and no rupture in 8 (5.0%). Ventricular septal defect (VSD) and aortic regurgitation (AR) were found in 59 (37%) and 45 (28%) patients respectively. An approach via the involved chamber was used in 86 patients (54%), aortotomy in 8 (5%), and a combined approach in 66 (41%). Either direct suture (56, 35%) or patch (104, 65%) closure were used to repair the SVA. The VSD was closed with a patch (44/59, 75%) or direct suture (15/59, 25%). aortic valve replacement (AVR) was performed in 23/45 (51%) and aortic valvuloplasty (AVP) in 9/45 (20%) patients combined with AR. There were 3 hospital deaths (1.9%) and 2 late deaths and 84% of the patients were followed up for (17.6 +/- 4.2) years. New York Heart Association functional class improved significantly after surgery (P< 0.01). Actuarial survival was 94% at 10 years, and 88% at 20 years. Conclusions Surgical treatment of SVA is safe and effective, ruptured SVA or unruptured SVA with VSD and/or AR should be repaired surgically as early as possible. However, late progressive AR is still a risk during long-term follow-up, and early aggressive measures are recommended. These include more use of a combined approach to achieve optimal evaluation of lesions, more patch repairs to reduce the chance of recurrence, and more AVR in patients with moderate to severe AR.