Fifteen years of aortic valve-sparing root replacement and impact of eccentric jets on late outcomes.

Abstract Background Valve-sparing root replacement (VSRR) is more challenging with eccentric aortic insufficiency (AI) due to cusp and root asymmetry, which may impact valve durability and survival. This study analyzed the effect of jet eccentricity on long-term outcomes in tricuspid (TAV) and bicuspid (BAV) valves. Methods From 2005-2019, 111 patients (65 TAV, 46 BAV) with >2+ AI underwent VSRR at an academic center. Pre- and post-operative echocardiograms were analyzed. Of these, 32 patients presented with concentric jets (29 TAV, 3 BAV) and 71 with eccentric jets (28 TAV, 43 BAV). Median (IQR) follow-up was 49 (12-93) months. Kaplan-Meier analysis and cumulative risk were used to compare long-term survival and valve-related reintervention. Results The mean age was 44 ± 12 years. Compared to TAV, more BAV patients presented with eccentric jets (93.5% vs 43.1%, p Conclusions In patients presenting for VSRR with >2+ AI, the risk of valve-related reintervention long-term is low after cusp repair in TAV and BAV. Current results suggest preoperative jet eccentricity does not impact long-term survival and valve durability.