Surgical Treatment in Patients With Aortic Regurgitation Due to Takayasu Arteritis

Risk factors and surgical prognosis in patients with aortic valve involvement caused by Takayasu arteritis

Objective

Aortic valve involvement is not uncommon in patients with Takayasu arteritis (TAK) and leading to poor prognosis. The aim of our study was to explore the risk factors of aortic valve involvement and to evaluate the prognosis in TAK patients with aortic valve involvement.

Method

In this retrospective study, 172 TAK patients were divided into groups with or without aortic valve involvement to identify the risk factors. Patients who underwent aortic valve surgical treatment were followed up to assess cumulative incidence of postoperative adverse events.

Results

A total of 92 TAK patients (53.49%) had aortic valvular lesion. The infiltration of inflammatory cells was found in surgical specimens of aortic valve. Numano type IIb, elevated high-sensitivity C-reactive protein (hs-CRP) level, and dilation of ascending aorta and aortic root were statistically associated with aortic valvular lesion in TAK patients (OR [95%CI] 6.853 [1.685–27.875], p=0.007; 4.896 [1.646–14.561], p=0.004; 4.509 [1.517–13.403], p=0.007; 9.340 [2.188–39.875], p=0.003). The 1-, 5-, and 7-year cumulative incidence of postoperative adverse events were 14.7%, 14.7%, and 31.8%, respectively. Surgical methods (p=0.024, hazard ratio (HR) 0.082) and postoperatively anti-inflammatory therapy (p=0.036, HR 0.144) were identified as potential predictors of postoperative adverse events.

Conclusions

Regularly echocardiogram screening is suggested in patients with Numano type IIb and aggressive treatment should be performed early in TAK patients. As for TAK patients with aortic valve surgery, aortic root replacement seems to be the preferred option and regular anti-inflammatory therapy may reduce the occurrence of adverse events of them.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13075-022-02788-9.

Transcatheter Aortic Valve Replacement for Aortic Regurgitation due to Takayasu Arteritis

Aortic regurgitation (AR) in patients suffering from Takayasu arteritis is considered a relatively common clinical condition. Aortic valve replacement as a surgical treatment, however, is known to hold a high risk of postoperative prosthetic valve detachment or anastomotic pseudoaneurysm. This pilot study reported on our initial experience with transcatheter aortic valve replacement (TAVR) for AR due to Takayasu arteritis. The outcome suggested that TAVR may be a potentially feasible alternative option for AR in Takayasu arteritis, especially in relatively aged and vulnerable patients.

Catastrophic Cardiac Complications of Takayasu's Arteritis

Takayasu's arteritis (TA) causes inflammation and necrosis of vessel walls, leading to aneurysm formation, extensive coronary damage and valvular abnormalities. We review a case of recurrent coronary, aortic and mitral valve involvement in a patient with TA and discuss the various treatment options available for such patients.