# Clinical results of combined aortic valve-sparing root replacement and mitral valve repair

## TL;DR

This study evaluates the long-term outcomes of combining aortic valve-sparing surgery with mitral valve repair, showing high survival and durability.

## Contribution

The study provides novel long-term clinical data on combined valve-sparing root replacement and mitral valve repair.

## Key findings

- 10-year survival rate was 90% with no hospital mortality.
- Freedom from reoperation at 10 years was 84%.
- Patients with connective tissue disorders had significantly lower freedom from reoperation (63% vs 91%).

## Abstract

Aortic valve-sparing root replacement using the reimplantation technique and mitral valve (MV) repair are well-established surgical approaches for the treatment of aortic root pathologies and mitral valve insufficiency. However, the management of concomitant diseases with a dual valve-preserving strategy remains poorly described. Therefore, the aim of this study is to evaluate the long-term outcomes of concomitant valve-sparing surgery and MV repair.

This case series includes all the patients who underwent combined valve-sparing root replacement and MV repair at Cliniques Universitaires Saint-Luc (Brussels, Belgium) between January 2000 and June 2022. Actual survival rate and freedom from reoperation were calculated by the Kaplan–Meier method, and the log rank test was used for statistical evaluation.

Forty-five patients were included in the study; they were divided into two groups (13 patients with and 32 patients without connective tissue disorders). There was no hospital mortality. Three patients (7%) required pacemaker implantation. Overall survival at 10 years was 90% (95% confidence interval [CI]: 64–97%). Furthermore, freedom from all reoperations at 10 years was 84% (95% CI: 64–93%). Analysing the two subgroups, we found no statistically significant difference in terms of 10-year survival (log rank P = 0.146). However, freedom from reoperation at 10 years was significantly lower in the connective tissue disorder group (63% vs 91%, log rank P = 0.031). Most patients treated with transaortic edge-to-edge repair required MV reoperation.

Combined valve-sparing root replacement with the reimplantation technique and MV operations are complex surgeries. However, they can be performed safely, with excellent long-term survival and repair durability. Applying standard Carpentier techniques for MV repair is crucial, especially in patients with connective tissue disorders.

Aortic valve-sparing root replacement with the reimplantation technique (VSRR) and mitral valve (MV) repair are well-established surgical interventions for the management of aortic root pathologies and mitral insufficiency (MI) [1, 2].