Reimplantation versus remodelling with ring annuloplasty: comparison of mid-term outcomes after valve-sparing aortic root replacement

OBJECTIVES: Remodelling with extra-aortic ring annuloplasty has emerged as an alternative approach to root reimplantation. However, no studies have yet compared outcomes between procedures. The aim of this study was to compare mid-term outcomes in patients undergoing reimplantation versus remodelling with extra-aortic annuloplasty. METHODS: From 2001 to 2017, 142 patients underwent root remodelling with extra-aortic annuloplasty (n = 83, 48 +/- 13 years) or a reimplantation technique (n = 59, 48 +/- 12 years) at the Montreal Heart Institute. No differences were observed in the incidence of connective tissue disease (24% vs 29%, P = 0.9) or preoperative aortic insufficiency > 3 (37% vs 23%, P = 0.24). However, in the remodelling group, there were more bicuspid aortic valves (31% vs 9%; P < 0.01), and the mean preoperative aortic annulus diameter was larger (27.2 +/- 3.6mm vs 25.6 +/- 2.4 mm; P = 0.01). The mean follow-up duration was 3.9 years (100% complete). RESULTS: There were no hospital deaths and 5 late deaths. At 5 years, overall survival was similar in both groups (100%, P = 0.98). Similarly, 5-year freedom from aortic valve reoperation was equivalent (97 +/- 2% in both groups, P = 0.95). Furthermore, 5-year survival free from aortic insufficiency > 2 or reoperation was 84 +/- 5% in the remodelling with annuloplasty group vs 83 +/- 6% in the reimplantation group (P = 0.62). The mean annular diameter was 24.3 +/- 0.5mm at 5 years vs 23.6 +/- 0.3mm at discharge in the remodelling group (P = 0.28) and 24.4 +/- 0.6mm vs 23.2 +/- 0.3 mm, respectively, in the reimplantation group (P = 0.1). CONCLUSIONS: Despite a higher prevalence of bicuspid aortic valves and larger aortic annular diameters, mid-term outcomes after remodelling with extra-aortic annuloplasty and reimplantation are comparable. Extra-aortic ring annuloplasty is effective at stabilizing annular dimensions.