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

Objectives: 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. Methods: 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. Results: 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. Conclusions: 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.