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Gofus J, Vojacek J, Karalko M, Zacek P, Kolesar A, Toporcer T, Urban M, Glac F, Cerny S, Homola P, Hlubocky J, Slautin A, Fila P, Zakova D, Sterba J, Rashid H, Van Linden A, Holubec T. Aortic valve performance after remodelling versus reimplantation in a propensity-matched comparison. Eur J Cardiothorac Surg 2024; 66:ezae234. [PMID: 39102871 DOI: 10.1093/ejcts/ezae234] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 05/09/2024] [Accepted: 06/10/2024] [Indexed: 08/07/2024] Open
Abstract
OBJECTIVES Both aortic root remodelling and aortic valve (AV) reimplantation have been used for valve-sparing root replacement in patients with aortic root aneurysm with or without aortic regurgitation. There is no clear evidence to support one technique over the another. This study aimed to compare remodelling with basal ring annuloplasty versus reimplantation on a multicentre level with the use of propensity-score matching. METHODS This was a retrospective international multicentre study of patients undergoing remodelling or reimplantation between 2010 and 2021. Twenty-three preoperative covariates (including root dimensions and valve characteristics) were used for propensity-score matching. Perioperative outcomes were analysed along with longer-term freedom from AV reoperation/reintervention and other major valve-related events. RESULTS Throughout the study period, 297 patients underwent remodelling and 281 had reimplantation. Using propensity-score matching, 112 pairs were selected and further compared. We did not find a statistically significant difference in perioperative outcomes between the matched groups. Patients after remodelling had significantly higher reintervention risk than after reimplantation over the median follow-up of 6 years (P = 0.016). The remodelling technique (P = 0.02), need for decalcification (P = 0.03) and degree of immediate postoperative AV regurgitation (P < 0.001) were defined as independent risk factors for later AV reintervention. After exclusion of patients with worse than mild AV regurgitation immediately after repair, both techniques functioned comparably (P = 0.089). CONCLUSIONS AV reimplantation was associated with better valve function in longer-term postoperatively than remodelling. If optimal immediate repair outcome was achieved, both techniques provided comparable AV function.
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Affiliation(s)
- Jan Gofus
- Department of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Jan Vojacek
- Department of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Mikita Karalko
- Department of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Pavel Zacek
- Department of Cardiac Surgery, Faculty of Medicine and University Hospital in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Adrian Kolesar
- Department of Cardiac Surgery, Faculty of Medicine and East Slovak Institute of Cardiovascular Disease, Pavol Jozef Šafárik University, Košice, Slovakia
| | - Tomas Toporcer
- Department of Cardiac Surgery, Faculty of Medicine and East Slovak Institute of Cardiovascular Disease, Pavol Jozef Šafárik University, Košice, Slovakia
| | - Martin Urban
- Department of Cardiac Surgery, Hospital AGEL Trinec-V Podlesí, Trinec, Czech Republic
| | - Filip Glac
- Department of Cardiac Surgery, Hospital AGEL Trinec-V Podlesí, Trinec, Czech Republic
| | - Stepan Cerny
- Department of Cardiac Surgery, Na Homolce Hospital, Prague, Czech Republic
- Department of Cardiovascular Surgery, University Hospital in Motol, Prague, Czech Republic
| | - Pavel Homola
- Department of Cardiac Surgery, Na Homolce Hospital, Prague, Czech Republic
| | - Jaroslav Hlubocky
- 2nd Department of Surgery, 1st Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Andrey Slautin
- 2nd Department of Surgery, 1st Faculty of Medicine and General University Hospital in Prague, Charles University, Prague, Czech Republic
| | - Petr Fila
- Department of Cardiovascular Surgery and Transplantation, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Daniela Zakova
- Department of Cardiovascular Surgery and Transplantation, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Sterba
- Department of Cardiovascular Surgery and Transplantation, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Hiwad Rashid
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Arnaud Van Linden
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Tomas Holubec
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt/Main, Germany
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Claus I, Giebels C, Ehrlich T, Schäfers HJ. Aortic Root Remodeling in the Tricuspid Aortic Valve. Ann Thorac Surg 2024:S0003-4975(24)00579-4. [PMID: 39053693 DOI: 10.1016/j.athoracsur.2024.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 06/14/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Aortic root remodeling is one of the principal forms of valve-preserving root replacement. Its value has been questioned by some, whereas others have achieved excellent valve durability. The purpose of this review is to summarize the existing information to determine which factors may have contributed both to failures and to successes. METHODS Publications on root remodeling for aneurysm or dissection with tricuspid aortic valves with >15 patients were reviewed for specific details of preoperative and intraoperative management. RESULTS The series were very heterogeneous. Most operations were performed for root aneurysm, and 10 publications included type A dissection. Connective tissue disease was present in 22% of patients. Mean patient age was 52 years, and 5-year survival varied between 58% and 100%. Most series did not include an annuloplasty. Importantly, no details on quantitative assessment of valve configuration were specified in most series, especially those with suboptimal valve function and durability. The introduction of the effective height concept to control valve configuration was associated with improved results and more frequent correction of cusp prolapse. Late freedom from aortic regurgitation and freedom from reoperation are good in the larger series. CONCLUSIONS Root remodeling can lead to excellent valve durability if quantitative intraoperative measurement of valve configuration is performed. The addition of an annuloplasty seems to improve aortic valve competence further, even though its effect on durability is not unequivocally proven. The long-term results of root remodeling are good, also in the second postoperative decade, and it is a valid form of valve-preserving root replacement.
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Affiliation(s)
- Isabelle Claus
- Department Cardiac Surgery, Ghent University Hospital, Ghent, Belgium.
| | - Christian Giebels
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Tristan Ehrlich
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Westpfalz-Klinikum, Kaiserslautern, Germany; Faculty of Medicine, Saarland University, Homburg/Saar, Germany
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Sá MP, Sultan I, Chu D. Invited Commentary: Annular Stabilization Is the Key to Connective Tissue Disorders. Am J Cardiol 2024; 215:87-88. [PMID: 38224727 DOI: 10.1016/j.amjcard.2023.12.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 12/29/2023] [Indexed: 01/17/2024]
Affiliation(s)
- Michel Pompeu Sá
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Division of Cardiac Surgery, University of Pittsburgh Medical Center Heart & Vascular Institute, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Division of Cardiac Surgery, University of Pittsburgh Medical Center Heart & Vascular Institute, Pittsburgh, Pennsylvania
| | - Danny Chu
- Department of Cardiothoracic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Division of Cardiac Surgery, University of Pittsburgh Medical Center Heart & Vascular Institute, Pittsburgh, Pennsylvania.
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Tseng EE, Boskovski M. Reimplantation vs Remodeling: End of the Debate? Ann Thorac Surg 2024; 117:508-509. [PMID: 37832928 DOI: 10.1016/j.athoracsur.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 10/15/2023]
Affiliation(s)
- Elaine E Tseng
- Division of Cardiothoracic Surgery, University of California San Francisco, 500 Parnassus Ave, Ste 405W, Box 0118, San Francisco, CA 94143; Department of Surgery, San Francisco Veterans Affairs HealthCare System, San Francisco, California.
| | - Marko Boskovski
- Division of Cardiothoracic Surgery, University of California San Francisco, 500 Parnassus Ave, Ste 405W, Box 0118, San Francisco, CA 94143; Department of Surgery, San Francisco Veterans Affairs HealthCare System, San Francisco, California
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Jasinski MJ. Aortic valve-sparing variants are getting closer. JTCVS Tech 2024; 23:24-25. [PMID: 38351996 PMCID: PMC10859666 DOI: 10.1016/j.xjtc.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Affiliation(s)
- Marek J Jasinski
- Clinical Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
- Royal Brompton and Harefield Hospital, Cardiothoracic Surgery, London, United Kingdom
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