Should the annulus be fixed in aortic valve-sparing root replacement with remodeling?

Objectives If the aortic root dilates after native aortic valve-sparing root reconstruction with remodeling, aortic regurgitation may recur. However, it has not been demonstrated clearly that the aortic root dilates after remodeling. Methods This study enrolled 15 patients who underwent an aortic valve-sparing operation with remodeling (2002-2014) but without any ventriculo-aortic junction (VAJ) fixation. Technically, special care was taken to pass the sutures through the fibrous annulus. The diameter of the aortic root (VAJ, neosinus of Valsalva, and sinotubular junction), degree of aortic regurgitation, and effective height of the aortic valve were measured in the patients. All patients had postoperative follow-up, and the median follow-up period was 7.3 (IQR: 3.1-8.3) years. Results The mean preoperative diameters of the VAJ, sinus of Valsalva, and sinotubular junction were 23.5 +/- 2.3 (20-27) mm, 51.1 +/- 7.2 (43-60) mm, and 42.4 +/- 9.4 (29-58) mm, respectively. The postoperative diameters of the VAJ changed from 21.6 +/- 2.6 (early) to 21.8 +/- 2.9 mm (late) (p = 0.75). The diameters of the sinus of Valsalva and sinotubular junction changed from 26.5 +/- 3.0 (early) to 28.5 +/- 4.2 mm (late) (p = 0.0013), and 22.4 +/- 3.0 (early) to 24.3 +/- 3.3 mm (late) (p = 0.0003), respectively. The effective height of the aortic valve changed from 9.7 +/- 1.3 (early) to 8.9 +/- 2.0 mm (late) (p = 0.08). The degree of aortic regurgitation (grade: 0-4) changed from 0.3 +/- 0.5 (early) to 1.2 +/- 0.8 (late) (p = 01558). Conclusions Significant VAJ dilation and changes in aortic valve configuration after our remodeling procedure were not observed. Therefore, fixation of the annulus with remodeling may not be needed for cases without preoperative dilation of the annulus.