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Lau C, Ram E, Harik L, Soletti G, Leith J, Mack CA, Gambardella I, Gaudino M, Girardi LN. Aortic valve degeneration after valve-sparing root replacement in patients with bicuspid aortopathy or connective tissue disorder. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00661-5. [PMID: 39084334 DOI: 10.1016/j.jtcvs.2024.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/14/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024]
Abstract
OBJECTIVE We sought to evaluate outcomes of valve-sparing root replacement (VSRR) in patients with bicuspid aortopathy (BAV) versus other connective tissue disorder (CTD). METHODS This was a single-center cohort study of consecutive patients undergoing VSRR via reimplantation from 2000 to 2023 with BAV or CTD. Operative outcomes, Kaplan-Meier survival estimates, and cumulative risk of reoperation and recurrent aortic insufficiency (AI) with the competing risk of death were assessed. RESULTS Of 516 patients who underwent VSRR, 109 (51.9%) had BAV and 101 (48.1%) had CTD. Patients with BAV were older (46.9 ± 10.4 vs 38.4 ± 14 years, P < .001) and more likely male (89.0% vs 56.4%, P < .001) and hypertensive (66.1% vs 28.7%, P < .001). Preoperative AI was similar (P = .57) between groups (30.3% mild, 18.3% moderate, 11.1% severe). Most patients had no/trivial immediate postoperative residual AI (96.3% vs 93.1%). Operative mortality was zero; postoperative adverse events were minimal. Mean clinical follow-up was 5.2 ± 4.4 years; 10-year survival was 95.6% versus 95.7% (P = .70). Echocardiographic follow-up was 3.9 ± 4.1 years; incidence of >2+ AI (9.7% vs 10.1%, P = 1.0) was similar between groups, whereas the incidence of moderate or greater aortic stenosis was greater with BAV (7.5% vs 0%, P = .02). Reoperation was low in both groups (3.7% vs 5.9%, P = .65). Competing risk analysis found no difference in reoperation hazard between BAV and CTD groups (hazard ratio, 0.36; 95% confidence interval, 0.07-1.81, P = .21). CONCLUSIONS Patients with BAV and CTD have excellent operative outcomes, no mortality, and minimal residual AI after VSRR. Although the incidence of recurrent AI was similar, patients with BAV are at risk for AS.
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Affiliation(s)
- Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
| | - Eilon Ram
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Giovanni Soletti
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Jordan Leith
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Charles A Mack
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | | | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
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Tran A, Shih E, Harrington KB, Schaffer JM, Banwait JK, Wang Z, DiMaio JM, Mack MJ, Ryan WH, Brinkman WT. Midterm durability of valve-sparing root replacement in bicuspid and tricuspid aortic valves. Proc AMIA Symp 2024; 37:569-575. [PMID: 38910820 PMCID: PMC11188821 DOI: 10.1080/08998280.2024.2346445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 04/15/2024] [Indexed: 06/25/2024] Open
Abstract
Background Among patients with bicuspid aortic valves (BAV) who are potential candidates for valve-sparing root replacement (VSRR), the long-term durability of this technique is not well understood. This study aimed to compare the clinical and echocardiographic outcomes of VSRR in those with BAV and tricuspid aortic valve (TAV) morphology. Methods This was a retrospective analysis of patients who underwent VSRR between 2007 and 2021 at a single center. Kaplan-Meier and log-rank analysis were used to estimate and compare freedom from mortality, progression to >2+ aortic insufficiency (AI), and reoperation between groups (BAV vs TAV). Preoperative and postoperative echocardiographic data were collected and assessed for temporal changes in mixed-effect models. Results A total of 185 patients (BAV, n = 52, 28.1%; TAV, n = 133, 71.9%) underwent VSRR. At baseline, BAV patients were younger (42.4 ± 11.6 vs 52.3 ± 12.6 years; P < 0.01) and had more severe AI (47.9% vs 27.0%; P = 0.02). Average cardiopulmonary bypass and cross-clamp times were similar. There were no differences in rates of postoperative complications, intensive care unit or hospital days, or 30-day readmission. TAV patients' 1-, 5-, and 8-year survival rates were 99.2% [95% CI 97.8-100], 96.7% [93.5-99.9%], and 92.2% [85.6-99.3%], respectively. Overall, there were no differences between groups regarding freedom from mortality (P = 0.18), reoperation (P = 0.51), or recurrent >2+ AI (P = 0.97). . Conclusions VSRR can be safely performed on patients with BAV and TAV morphology, yielding similar midterm freedom from mortality, recurrent >2+ AI, and reoperation. This technique should be considered in carefully selected patients with aortic root pathology and BAV anatomy when performed at experienced centers.
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Affiliation(s)
- Anthony Tran
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas, USA
| | - Emily Shih
- Department of General Surgery, Baylor University Medical Center, Dallas, Texas, USA
| | - Katherine B. Harrington
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas, USA
| | - Justin M. Schaffer
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas, USA
| | | | - Zuyue Wang
- Department of Cardiology, Baylor Scott and White The Heart Hospital, Plano, Texas, USA
| | - J. Michael DiMaio
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas, USA
| | - Michael J. Mack
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas, USA
| | - William H. Ryan
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas, USA
| | - William T. Brinkman
- Department of Cardiothoracic Surgery, Baylor Scott and White The Heart Hospital, Plano, Texas, USA
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Desai ND, Kelly JJ, Iyengar A, Zhao Y, Cannon BJ, Grimm JC, Patrick WL, Ibrahim M, Freas M, Siki M, Szeto WY, Bavaria JE. Midterm Results of an Algorithmic 3-Pronged Approach to Bicuspid Aortic Valve Repair. Ann Thorac Surg 2024; 117:950-957. [PMID: 37517532 DOI: 10.1016/j.athoracsur.2023.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/27/2023] [Accepted: 07/08/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND This study evaluated midterm outcomes of a 3-pronged algorithm for bicuspid aortic valve (BAV) repair. Valve-sparing root reimplantation (VSRR) was performed for patients with aortic root dilatation. In those without a root aneurysm, external subannular ring (ESAR) was performed for annuli ≥28 mm and subcommissural annuloplasty (SCA) for annuli <28 mm. METHODS This was a retrospective review of prospectively collected data of 242 patients undergoing primary BAV repair from April 29, 2004, to March 1, 2023, at a single institution. Primary end points were mortality, structural valve degeneration (SVD), which was defined as a composite of more than moderate aortic insufficiency or severe aortic stenosis, and reintervention. RESULTS The algorithm was used to treat 201 patients; of these, 130 underwent VSRR, 35 had ESAR, and 36 underwent SCA. Most were men with mean age of 43.8 years (SD, 12.0 years), which was similar between groups. Preoperative aortic insufficiency more than moderate was more common for ESAR compared with VSRR and SCA (74.3% vs 37.7% vs 44.4%, P < .001). At 30 days, mortality was 0.8% (n = 1) for VSRR and 0% for ESAR and SCA. At 6 years, overall Kaplan-Meier survival was 98.9% (95% CI, 97.3%-100%), with no differences between groups (P = .5). The cumulative incidence of SVD was 4.7% (95% CI, 0.1%-9.2%) for VSRR, 6.4% (95% CI, 0%-14.6%) for ESAR, and 0% for SCA (P = .4). Similarly, the cumulative incidence of reintervention with all-cause mortality as a competing risk was 2.2% (95% CI, 0.4%-6.9%), 6.1% (95% CI, 1%-17.9%), and 0% for VSRR, ESAR, and SCA, respectively (P = .506). CONCLUSIONS A 3-pronged algorithmic approach to BAV repair results in excellent survival and freedom from reoperation at 6 years.
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Affiliation(s)
- Nimesh D Desai
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania.
| | - John J Kelly
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
| | - Amit Iyengar
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Yu Zhao
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brittany J Cannon
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joshua C Grimm
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - William L Patrick
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
| | - Michael Ibrahim
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Melanie Freas
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary Siki
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joseph E Bavaria
- Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
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Singh SK, Levine D, Patel P, Norton E, Wang C, Kurlansky P, Childress P, Chung M, Olakunle O, George I, Leshnower B, Chen EP, Takayama H. Reintervention after valve-sparing aortic root replacement: A comprehensive analysis of 781 David V procedures. J Thorac Cardiovasc Surg 2024; 167:1229-1238.e7. [PMID: 37156363 DOI: 10.1016/j.jtcvs.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/05/2023] [Accepted: 04/12/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Studies of reintervention after valve-sparing aortic root replacement (VSRR) are limited by sample size and failure to evaluate all types of reinterventions, including distal aorta and transcatheter interventions. In this report, reintervention after VSRR using a large patient cohort was comprehensively analyzed. METHODS In a series involving 2 academic aortic centers, 781 consecutive patients from 2005 to 2020 undergoing David V VSRR for aortic aneurysm (91%) or dissection (9%) were included. Median age was 50 years, and 23% had a bicuspid aortic valve (AV). Median follow-up was 7.0 years. Open or transcatheter reintervention on the AV, proximal, or distal thoracic aorta was identified. Cumulative incidence was calculated, and subdistribution hazard models identified factors associated with reintervention. Time-dependent incidence of reintervention was plotted using risk-hazard functions. RESULTS Sixty-eight reinterventions (57 open, 11 transcatheter) were performed. Reinterventions were divided by indication into degenerative AV (n = 26, including 1 transcatheter aortic valve replacement), endocarditis (n = 11), proximal aorta (n = 8), and distal aorta (n = 23, including 10 thoracic endovascular aortic repairs). Risk of reintervention for endocarditis peaked 1 to 3 years after VSRR, whereas other indications had stable, low rates of occurrence throughout the follow-up period. The cumulative incidence of reintervention was 12.5% whereas the cumulative incidence of AV reintervention was 7.0% at 10 years and was associated with residual postoperative aortic insufficiency. In-hospital mortality after reintervention was 3%. CONCLUSIONS Reintervention rates after VSRR are relatively low in long-term follow-up and can be performed with acceptable operative risk. The majority of reinterventions are performed for indications other than AV degeneration, with the timing of reintervention varying by the specific clinical indication.
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Affiliation(s)
- Sameer K Singh
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Irving Medical Center, New York, NY
| | - Dov Levine
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Irving Medical Center, New York, NY
| | - Parth Patel
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Elizabeth Norton
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Chunhui Wang
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Irving Medical Center, New York, NY
| | - Paul Kurlansky
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Irving Medical Center, New York, NY
| | - Patra Childress
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Irving Medical Center, New York, NY
| | - Megan Chung
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Irving Medical Center, New York, NY
| | - Oreoluwa Olakunle
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Isaac George
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Irving Medical Center, New York, NY
| | - Bradley Leshnower
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga
| | - Edward P Chen
- Division of Cardiovascular and Thoracic Surgery, Duke University Medical Center, Durham, NC
| | - Hiroo Takayama
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Irving Medical Center, New York, NY.
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Baric D, Sliskovic N, Sestan G, Gjorgjievska S, Unic D, Kusurin M, Varvodic J, Safaric Oremus Z, Jurin I, Bulj N, Susnjar D, Rudez I. Aortic Valve Repair with External Annuloplasty in Bicuspid versus Tricuspid Aortic Valve Patients. J Cardiovasc Dev Dis 2024; 11:17. [PMID: 38248887 PMCID: PMC10816450 DOI: 10.3390/jcdd11010017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/13/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Surgical repair for regurgitant bicuspid aortic valve (BAV) is promising but underutilized due to perceived complexities and lack of long-term data. This study evaluated the efficacy of valve-sparing root remodeling (VSRR) or isolated valve repair combined with calibrated external ring annuloplasty in BAV versus tricuspid aortic valve (TAV) patients. All patients operated on for aortic regurgitation and/or aneurysm at our institution between 2014 and 2022 were included and entered into the Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry (AVIATOR). Patients with successful repair at index surgery (100% in the BAV group, 93% in the TAV group, p = 0.044) were included in a systemic follow-up with echocardiography at regular intervals. Among 132 patients, 58 were in the BAV (44%) and 74 in the TAV group (56%). There were no inter-group differences in preoperative patient characteristics, except BAV patients being significantly younger (47 ± 18 y vs. 60 ± 14 y, p < 0.001) and having narrower aortic roots at the level of sinuses (41 ± 6 mm vs. 46 ± 13 mm, p < 0.001) and sinotubular junctions (39 ± 10 mm vs. 42 ± 11, p = 0.032). No perioperative deaths were recorded. At four years, there was no significant difference in terms of overall survival (96.3% BAV vs. 97.2% TAV, p = 0.373), freedom from valve reintervention (85.2% BAV vs. 93.4% TAV, p = 0.905), and freedom from severe aortic regurgitation (94.1% BAV vs. 82.9% TAV, p = 0.222). Surgical repair of BAV combined with extra-aortic annuloplasty can be performed with low perioperative morbidity and mortality and excellent mid-term results which are comparable to TAV repair.
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Affiliation(s)
- Davor Baric
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10 000 Zagreb, Croatia; (N.S.); (G.S.); (S.G.); (D.U.); (M.K.); (J.V.); (D.S.); (I.R.)
| | - Nikola Sliskovic
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10 000 Zagreb, Croatia; (N.S.); (G.S.); (S.G.); (D.U.); (M.K.); (J.V.); (D.S.); (I.R.)
| | - Gloria Sestan
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10 000 Zagreb, Croatia; (N.S.); (G.S.); (S.G.); (D.U.); (M.K.); (J.V.); (D.S.); (I.R.)
| | - Savica Gjorgjievska
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10 000 Zagreb, Croatia; (N.S.); (G.S.); (S.G.); (D.U.); (M.K.); (J.V.); (D.S.); (I.R.)
| | - Daniel Unic
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10 000 Zagreb, Croatia; (N.S.); (G.S.); (S.G.); (D.U.); (M.K.); (J.V.); (D.S.); (I.R.)
| | - Marko Kusurin
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10 000 Zagreb, Croatia; (N.S.); (G.S.); (S.G.); (D.U.); (M.K.); (J.V.); (D.S.); (I.R.)
| | - Josip Varvodic
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10 000 Zagreb, Croatia; (N.S.); (G.S.); (S.G.); (D.U.); (M.K.); (J.V.); (D.S.); (I.R.)
| | - Zrinka Safaric Oremus
- Department of Anesthesiology, Reanimatology and Intensive Care Medicine, Dubrava University Hospital, 10 000 Zagreb, Croatia;
| | - Ivana Jurin
- Department of Cardiovascular Diseases, Dubrava University Hospital, 10 000 Zagreb, Croatia;
| | - Nikola Bulj
- Department of Cardiology, University Hospital Centre “Sestre Milosrdnice”, 10 000 Zagreb, Croatia;
| | - Dubravka Susnjar
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10 000 Zagreb, Croatia; (N.S.); (G.S.); (S.G.); (D.U.); (M.K.); (J.V.); (D.S.); (I.R.)
| | - Igor Rudez
- Department of Cardiac and Transplant Surgery, Dubrava University Hospital, 10 000 Zagreb, Croatia; (N.S.); (G.S.); (S.G.); (D.U.); (M.K.); (J.V.); (D.S.); (I.R.)
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Dolmaci OB, Hilhorst TL, Malekzadeh A, Mertens BJ, Klautz RJ, Poelmann RE, Grewal N. The Prevalence of Coronary Artery Disease in Bicuspid Aortic Valve Patients: An Overview of the Literature. AORTA (STAMFORD, CONN.) 2023; 11:191-197. [PMID: 38698623 PMCID: PMC11219131 DOI: 10.1055/s-0044-1785190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/07/2024] [Indexed: 05/05/2024]
Abstract
The prevalence of coronary artery disease (CAD) in bicuspid aortic valve (BAV) patients is a debatable topic. Several studies have indicated that BAV patients have a lower prevalence of CAD compared with patients with a tricuspid aortic valve (TAV), but the effects of age and gender have not always been considered. This systematic review provides an overview of articles which report on CAD in BAV and TAV patients. Searches were executed in April 2021 and January 2022 according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines in three online databases: Medline, Embase, and Scopus. Screening and data extraction was done by two investigators separately. Primary and secondary outcomes were compared between BAV and TAV patients; a fixed effects model was used for correcting on confounders. Literature search yielded 1,529 articles with 44 being eligible for inclusion. BAV patients were younger (56.4 ± 8.3 years) than TAV patients (64 ± 10.3 years, p < 0.001). All CAD risk factors and CAD were more prevalent in TAV patients. No significant difference remained after correcting for age and gender as confounders. BAV patients have a lower prevalence of CAD and CAD risk factors compared with TAV patients. However, when the age differences between both groups are considered in the analyses, a similar prevalence of both CAD and CAD risk factors is found.
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Affiliation(s)
- Onur B. Dolmaci
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Tijmen L. Hilhorst
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Arjan Malekzadeh
- Medical Library, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
| | - Bart J.A. Mertens
- Department of Statistics, Leiden University Medical Center, Leiden, Netherlands
| | - Robert J.M. Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Robert E. Poelmann
- Institute of Biology, Leiden University, Sylvius Laboratory, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
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7
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Svensson LG, Vargo PR, Desai MY, Kalahasti V, Griffin B, Roselli EE, Rosinski BF, Rajeswaran J, Blackstone EH. Aortic valve reimplantation in patients with connective tissue disorders: Are the leaflets durable? J Thorac Cardiovasc Surg 2023; 166:1617-1626.e6. [PMID: 36740496 DOI: 10.1016/j.jtcvs.2022.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/27/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The durability of reimplanted myxomatous aortic valves in root replacements for patients with connective tissue disorders (CTD) is unclear; therefore, we sought to evaluate the long-term resilience of these repairs. METHODS From January 1980 to January 2020, 214 patients with CTD and 645 without CTD underwent primary, elective aortic valve reimplantation operations at Cleveland Clinic. The CTD cohort included 164 (77%) with Marfan, 23 (11%) with Loeys-Dietz, and 7 (3.3%) with Ehlers-Danlos CTD. We accounted for differing patient characteristics between the groups by propensity score matching to compare outcomes, yielding 96 matched pairs. Longitudinal echocardiographic measures were compared using nonlinear mixed effects models. RESULTS In the CTD cohort, there were no operative mortalities (30-day or in-hospital), 1 (0.47%) stroke, and 1 (0.47%) early in-hospital reoperation for valve dysfunction. Ten-year prevalence of no aortic regurgitation was 86%, mild 11%, and moderate 3%. Ten-year freedom from reoperation was 97%. In propensity matched cohorts, there were no significant differences in in-hospital outcomes, longitudinal aortic regurgitation and mean gradient, risk of reoperation on the aortic valve, or risk of late death. CONCLUSIONS Aortic valve reimplantation is a durable operation in patients with CTD and root aneurysms. These patients do not experience early degeneration of their reimplanted aortic valves.
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Affiliation(s)
- Lars G Svensson
- Aorta Center, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Patrick R Vargo
- Aorta Center, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Milind Y Desai
- Aorta Center, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Vidyasagar Kalahasti
- Aorta Center, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian Griffin
- Aorta Center, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Cardiovascular Medicine, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric E Roselli
- Aorta Center, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brad F Rosinski
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jeevanantham Rajeswaran
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
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8
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Zuo Y, Tan R, Qin C. Outcomes of valve-sparing aortic root replacement in patients with bicuspid aortic valve and tricuspid aortic valve: a systematic review and meta-analysis. J Cardiothorac Surg 2023; 18:206. [PMID: 37400892 DOI: 10.1186/s13019-023-02329-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 06/29/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Valve-sparing aortic root replacement (VSARR) is a safe and effective surgical procedure to treat aortic root aneurysm. This meta-analysis aimed to investigate how this procedure might differ in patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV). DESIGN Meta-analysis with meta-regression and systematic review. SETTING Systematic search in the following databases: PubMed, Cochrane Central Register of Controlled Trials, and Embase. INTERVENTIONS All observational studies of VSARR in patients with BAV or TAV were included in our study. Studies were included without any restrictions on language or publication date. A trial sequential analysis and a post-hoc meta-regression was performed on the main outcomes. RESULT Eleven articles met the inclusion criteria. A total of 1138 patients in BAV group, and 2125 patients in TAV group. No significant differences in gender and age were observed between BAV and TAV patients. BAV and TAV patients showed no differences in in-hospital mortality rate [0.00% vs. 1.93%; RR (95% CI) 0.33 (0.09, 1.26), I2 = 0%, P = 0.11] and the rate of in-hospital reoperation [5.64% vs. 5.99%; RR (95% CI) 1.01(0.59, 1.73), I2 = 33%, P = 0.98]. The overall long-term mortality rate of BAV patients was better than that of TAV patients [1.63% vs. 8.15%; RR (95% CI) 0.34 (0.13, 0.86), I2 = 0%, P = 0.02]. During the follow-up observation period, patients in TAV group showed small but no statistic advantage in 3-year, 5-year, and over 10-year incidences of reintervention. Regarding the secondary endpoints, the two groups showed similar aortic cross-clamping time and total cardiopulmonary bypass time. CONCLUSION The VSARR techniques yielded similar clinical outcomes in both BAV and TAV patients. Although patients with BAV might have a higher incidence of reinterventions after initial VSARR, it is still a safe and effective approach to treat aortic root dilation with or without aortic valve insufficiency. TAV patients showed small but no statistic advantage in long-term (over 10 years) reintervention rate, which means, patients with BAV may face a higher risk of reintervention in the clinic.
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Affiliation(s)
- Yiding Zuo
- Department of Anesthesia, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ruixi Tan
- Department of Anesthesia, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Chaoyi Qin
- Department of Cardiovascular Surgery and Cardiovascular Surgery Research Laboratory, West China Hospital, Sichuan University, 37th Guoxue Road, Chengdu, 610041, China.
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Abstract
The clinical outcome of severe aortic regurgitation (AR) remains suboptimal, but surgery has been shown to have survival benefit over medical therapy. Postoperative survival is inferior in patients with reduced left ventricular function, and therefore early surgical intervention is recommended. Aortic valvuloplasty (AVP) is an attractive option to avoid the major drawbacks of prosthetic valves but has not been widely adopted. The etiology of AR is classified functionally into three groups: normal leaflet motion (type I), cusp prolapse (type II), and restriction (type III). Type I with dilatation of the sinus of Valsalva (type Ib) can be repaired by aortic valve reimplantation or aortic root remodeling with similar valve stability. Type I with dilatation of the aortic annulus (type Ic) can be managed by annuloplasty. Type II can be corrected by plication or resuspension techniques. Pericardial patch is necessary in AVP for type Id (perforation/fenestration) and type III but is associated with risk of recurrence. Bicuspid aortic valve is classified according to commissure angle: symmetrical, asymmetrical, and very asymmetrical. Tricuspidization is recommended for repair of very asymmetrical valves to avoid postoperative stenosis. Recent progress has achieved similar reoperation rates between bicuspid and tricuspid aortic valve repair. For Marfan syndrome, valve-sparing root replacement is advantageous compared to Bentall operation regarding late survival, thromboembolic and hemorrhagic events, and endocarditis. Similar findings have been reported in acute aortic dissection. Both remodeling and reimplantation procedures provide similar favorable outcomes in these settings. Recent advances in AVP are summarized by quantitative assessment of cusp configuration (effective height and geometric height), graft size decision, use of template to cut the graft, and videoscopic assessment of post-repair cusp configuration. Due to these advances, AVP shows superior results to replacement surgery. Further concrete evidence with larger case volumes and longer observation periods are necessary to popularize AVP.
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10
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Serna-Gallegos D, Sultan I. Commentary: Aortic valve repair: How much is too much? JTCVS Tech 2022; 14:73-74. [PMID: 35967215 PMCID: PMC9366510 DOI: 10.1016/j.xjtc.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/18/2022] [Indexed: 11/22/2022] Open
Affiliation(s)
- Derek Serna-Gallegos
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
| | - Ibrahim Sultan
- Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pa
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pa
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11
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Patrick WL, Rosen JL, Bavaria JE, Ahmed S, Freas A, Yarlagadda S, Cannon B, Iyengar A, Kelly JJ, Zhao Y, Grimm JC, Szeto WY, Desai ND. Valve-sparing Root Reimplantation In Patients With Left Ventricular Dilation. Eur J Cardiothorac Surg 2022; 62:6647842. [PMID: 35861386 DOI: 10.1093/ejcts/ezac393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/29/2022] [Accepted: 07/19/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the association between left ventricular (LV) dilation and outcomes following valve-sparing root reimplantation. METHODS Patients with an indexed left ventricular internal diameter during systole (iLVIDS) of ≥ 2.0 cm/m2 were categorized as having LV dilation. Outcomes were post-operative aortic insufficiency (AI), re-intervention, and all-cause mortality. The cumulative incidence of each outcome was computed using the Kaplan-Meier estimator. Adjusted comparisons between strata were performed for each outcome using a Cox proportional-hazards model. Where possible, the competing risk of death was accounted for. Multilevel mixed-effects ordered logistic regression was performed for AI grade at follow-up. RESULTS There were 295 patients of whom 52 had LV dilation. Operative outcomes were excellent; there were no significant differences between groups. Patients with LV dilation demonstrated significant improvement in iLVIDS overtime. There was no association between LV dilation and post-operative AI grade >2 (HR 0.88, 95% CI 0.21 to 3.67, p = 0.89) or odds of increased AI grade overtime (OR = 0.76, 95% CI 0.30 to 1.93, p = 0.57). There were no re-interventions among those with LV dilation. Adjusted mortality was significantly higher among those with LV dilation (HR 5.56, 95% CI 1.56 to 19.9), however, deaths were unrelated to aortic valve dilation. CONCLUSIONS Left ventricular dilation is not associated with poorer operative outcomes, post-operative AI, or re-intervention. It is associated with increased risk of mortality, though not from valvular dysfunction. LV dilation should not deter VSRR when otherwise indicated.
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Affiliation(s)
- William L Patrick
- Division of Cardiovascular Surgery, University of Pennsylvania.,Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania.,Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Philadelphia, Pennsylvania
| | - Jake L Rosen
- Division of Cardiovascular Surgery, University of Pennsylvania
| | | | - Sania Ahmed
- Division of Cardiovascular Surgery, University of Pennsylvania
| | - Andrew Freas
- Division of Cardiovascular Surgery, University of Pennsylvania
| | | | - Brittany Cannon
- Division of Cardiovascular Surgery, University of Pennsylvania
| | - Amit Iyengar
- Division of Cardiovascular Surgery, University of Pennsylvania
| | - John J Kelly
- Division of Cardiovascular Surgery, University of Pennsylvania
| | - Yu Zhao
- Division of Cardiovascular Surgery, University of Pennsylvania.,Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Joshua C Grimm
- Division of Cardiovascular Surgery, University of Pennsylvania
| | - Wilson Y Szeto
- Division of Cardiovascular Surgery, University of Pennsylvania
| | - Nimesh D Desai
- Division of Cardiovascular Surgery, University of Pennsylvania.,Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania.,Penn Cardiovascular Outcomes, Quality, & Evaluative Research Center, Philadelphia, Pennsylvania
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12
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Jiang W, Long XM, Wei KQ, Li SC, Zhang Z, He BF, Li H. Application effect of thoracoscopic tricuspid valvuloplasty in geriatric patients with tricuspid valve disease. World J Clin Cases 2022; 10:4810-4817. [PMID: 35801058 PMCID: PMC9198848 DOI: 10.12998/wjcc.v10.i15.4810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/28/2022] [Accepted: 03/26/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Thoracoscopic-assisted technology can ensure that doctors can implement minimally invasive treatment through the right intercostal incision or small incision of the lower sternum. This approach not only can achieve a cardiac correction effect equivalent to that of a thoracotomy but also has the benefit of a clear surgical field ensuring the safety of surgical treatment.
AIM To investigate the effect of thoracoscopic tricuspid valvuloplasty in patients with tricuspid valve disease.
METHODS A total of 41 patients with tricuspid valve disease underwent traditional thoracotomy treatment between January 2018 and June 2020. Forty-one patients with tricuspid valve disease who underwent thoracoscopic tricuspid valvuloplasty treatment between July 2020 and June 2021 in our hospital were selected as controls for our retrospective analysis. The study group underwent thoracoscopic tricuspid valvuloplasty, while traditional thoracotomy was performed in the control group. The operation conditions (the duration of extracorporeal circulation, aorta blocking, endotracheal intubation, and surgery), inflammatory response-related indices (C-reactive protein and white blood cell count) before and after surgery, parameters related to myocardial injury (myocardial troponin T, creatine kinase isoenzyme, creatine kinase, and lactate dehydrogenase), and the incidence of adverse events in the two groups was counted.
RESULTS The duration of extracorporeal circulation (109.35 ± 50.31 min), aortic occlusion (94.26 ± 59.61 min), endotracheal intubation (12.59 ± 3.54 h), and hospital stay (5.29 ± 2.34 d) in the study group were shorter than those in the control group (114.91 ± 46.98 min, 101.37 ± 61.44 min, 13.11 ± 4.01 h, 7.09 ± 3.11 d, respectively). The difference in hospital stay between the two groups was statistically significant (P < 0.05). Serum C-reactive protein level (4.69 ± 1.35 mg/L) and white blood cell count (6.21 ± 1.97 × 109/L) in the study group were found to be not significantly different than those in the control group (5.01 ± 1.18 mg/L, 5.98 ± 2.01 × 109/L, respectively; P > 0.05). Myocardial troponin T (0.04 ± 0.02 ng/mL), creatine kinase isoenzyme (4.02 ± 1.11 mg/mL), creatine kinase (91.35 ± 10.44 U/L), and lactate dehydrogenase (179.81 ± 60.04 U/L) in the study group were also not statistically significant different than those in the control group (0.05 ± 0.03 ng/mL, 3.97 ± 1.05 mg/mL, 89.69 ± 13.05 U/L, 186.35 ± 56.96 U/L; P > 0.05). After the operation, serum C-reactive protein level (7.89 ± 1.73 mg/L) and white blood cell count (10.76 ± 2.35 × 109/L) in the study group were significantly lower than those in the control group (9.96 ± 2.04 mg/L, 14.84 ± 3.07 × 109/L, respectively) (P < 0.05). In addition, myocardial troponin T (0.89 ± 0.32 ng/mL), creatine kinase isoenzyme (26.96 ± 4.95 mg/mL), creatine kinase (608.32 ± 202.33 U/L), and lactate dehydrogenase (282.56 ± 101.34 U/L) in the study group were lower than those in the control group (2.61 ± 0.69 ng/mL, 34.37 ± 6.87 mg/mL, 689.94 ± 214.64 U/L, 369.15 ± 114.46 U/L) (P < 0.05). The incidence of adverse events in the study group (4.88%) was lower than that in the control group (19.51%) (P < 0.05).
CONCLUSION Thoracoscopic tricuspid valvuloplasty can achieve good results in treating patients with tricuspid valve disease, reduce the risk of adverse events, and promote the rapid recovery of patients.
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Affiliation(s)
- Wei Jiang
- Department of Cardiothoracic and Vascular Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Xiao-Mao Long
- Department of Cardiothoracic and Vascular Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Ke-Quan Wei
- Department of Cardiothoracic and Vascular Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Si-Cong Li
- Department of Cardiothoracic and Vascular Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Ze Zhang
- Department of Cardiothoracic and Vascular Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Bang-Fu He
- Department of Cardiothoracic and Vascular Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Hui Li
- Department of Cardiothoracic and Vascular Surgery, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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13
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Manganiello S, Soquet J, Mugnier A, Rousse N, Juthier F, Banfi C, Loobuyck V, Coisne A, Richardson M, Marechaux S, Moussa MD, Robin E, Pinçon C, Prat A, Vincentelli A. David Procedure: A 21-Year Experience with 300 Patients. Ann Thorac Surg 2022; 115:1403-1410. [DOI: 10.1016/j.athoracsur.2022.04.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 04/02/2022] [Accepted: 04/23/2022] [Indexed: 11/01/2022]
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14
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Impact of Aortic Valve Effective Height following Valve-Sparing Root Replacement on Postoperative Insufficiency and Reoperation. J Thorac Cardiovasc Surg 2022; 164:1672-1680.e3. [DOI: 10.1016/j.jtcvs.2022.02.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 02/10/2022] [Accepted: 02/22/2022] [Indexed: 11/18/2022]
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15
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Czerny M, Harringer W. Aortenchirurgie 50 Jahre – eine Zeitreise durch das Organ Aorta. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2022. [DOI: 10.1007/s00398-021-00473-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Mokashi SA, Rosinski BF, Desai MY, Griffin BP, Hammer DF, Kalahasti V, Johnston DR, Rajeswaran J, Roselli EE, Blackstone EH, Svensson LG. Aortic root replacement with bicuspid valve reimplantation: Are outcomes and valve durability comparable to those of tricuspid valve reimplantation? J Thorac Cardiovasc Surg 2022; 163:51-63.e5. [PMID: 32684389 DOI: 10.1016/j.jtcvs.2020.02.147] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To assess intermediate-term outcomes of aortic root replacement with valve-sparing reimplantation of bicuspid aortic valves (BAV), compared with tricuspid aortic valves (TAV). METHODS From January 2002 to July 2017, 92 adults underwent aortic root replacement with BAV reimplantation and 515 with TAV reimplantation at the Cleveland Clinic. Balancing-score matching based on 28 preoperative variables yielded 71 well-matched BAV and TAV pairs (77% of possible pairs) for comparison of postoperative mortality and morbidity, longitudinal echocardiogram data, aortic valve reoperation, and survival. RESULTS In the BAV group, 1 hospital death occurred (1.1%); mortality among all reimplantations was 0.2%. Among matched patients, procedural morbidity was low and similar between BAV and TAV groups (1 stroke in TAV group; renal failure requiring dialysis, 1 patient each; red cell transfusion, 25% each). Five-year results: Severe aortic regurgitation was present in 7.4% of the BAV group and 2.9% of the TAV group (P = .7); 39% of BAV and 65% of TAV patients had none. Higher mean gradients (10 vs 7.4 mm Hg; P = .001) and left ventricular mass index (111 vs 101 g/m2; P = .5) were present in BAV patients. Freedom from aortic valve reoperation was 94% in the BAV group and 98% in the TAV group (P = .10), and survival was 100% and 95%, respectively (P = .07). CONCLUSIONS Both BAV and TAV reimplantations can be performed with equal safety and good midterm outcomes; however, the constellation of higher gradients, less ventricular reverse remodeling, and more aortic valve reoperations with BAV reimplantations raises concerns requiring continued long-term surveillance.
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Affiliation(s)
- Suyog A Mokashi
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brad F Rosinski
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Milind Y Desai
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; The Aorta Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian P Griffin
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; The Aorta Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Donald F Hammer
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; The Aorta Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Vidyasagar Kalahasti
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Douglas R Johnston
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; The Aorta Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jeevanantham Rajeswaran
- Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eric E Roselli
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; The Aorta Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; The Aorta Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Lars G Svensson
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; The Aorta Center, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
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17
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Shah VN, Kilcoyne MF, Buckley M, Orlov OI, Sicouri S, Plestis KA. How We Perform a David Procedure With an Upper Hemisternotomy Approach. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2021; 16:545-552. [PMID: 34882491 DOI: 10.1177/15569845211045965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Valve-sparing aortic root replacement (David procedure) is the technique of choice in appropriately selected patients with aortic root aneurysms. These procedures are seldom performed in a minimally invasive fashion. We describe our systematic approach to the David procedure using an upper hemisternotomy (UHS). Methods: Our method involves a J-type UHS exiting the right third or fourth intercostal space. Ascending aortic and femoral venous cannulation are performed using the Seldinger technique under transesophageal echocardiographic guidance. Between August 2005 and August 2014, 27 patients underwent an isolated elective David procedure using a full sternotomy (FS). Sixteen underwent an isolated elective UHS David procedure from May 2015 to February 2019. Perioperative safety outcomes were compared between the 2 cohorts. Results: The UHS and FS David cohorts were primarily male (87.5% and 85.2%, respectively) and 51 and 50 years old on average, respectively. Custodiol-histidine-tryptophan-ketoglutarate cardioplegia (93.8% vs 37.0%, P < 0.001) and Cor-Knot (100% vs 0%, P < 0.001) were used significantly more in the UHS David cohort. There were no significant differences in cardiopulmonary bypass (200 [183-208] vs 212 [183-223] min, P = 0.309) and aortic cross-clamp (169 [155-179] vs 188 [155-199] min, P = 0.128) times in the UHS and FS cohorts. There were no instances of hospital or 30-day mortality in either cohort. Intensive care unit and hospital stays were comparable between the 2 cohorts. Conclusions: The David procedure via UHS is a safe and reproducible technique for aortic root replacement.
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Affiliation(s)
- Vishal N Shah
- Department of Cardiothoracic Surgery, 12284University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Meghan Buckley
- 20284Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Oleg I Orlov
- 20284Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Serge Sicouri
- 20284Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Konstadinos A Plestis
- Department of Cardiothoracic Surgery, 6529Thomas Jefferson University Hospital, Philadelphia, PA, USA
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18
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Patel HN, Abdullah M, Tang GH. TAVR in Prior Valve-Sparing Aortic Root Replacement: Critical Factors to Consider to Achieve Successful Outcomes. JACC Case Rep 2021; 3:1803-1805. [PMID: 34917958 PMCID: PMC8642720 DOI: 10.1016/j.jaccas.2021.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Hena N. Patel
- Division of Cardiology, University of Chicago, Chicago, Illinois, USA
| | - Mohamed Abdullah
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
| | - Gilbert H.L. Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA
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19
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Cekmecelioglu D, Preventza O, Dougherty KG, Chatterjee S, Green SY, Silva GV, Díez JG, Coselli JS. Transcatheter valve-in-valve implantation for degenerated stentless aortic bioroots. Ann Cardiothorac Surg 2021; 10:641-650. [PMID: 34733691 DOI: 10.21037/acs-2021-tviv-124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 07/29/2021] [Indexed: 11/06/2022]
Abstract
Background Open surgical repair of a failed valve-sparing aortic root replacement (VSARR) or stentless bioroot aortic root replacement (bio-ARR) entails significant operative risks. Whether valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) is feasible in patients with a previous VSARR or stentless bio-ARR remains unclear, given lingering concerns about the ill-defined aortic annulus in these patients and the potential for coronary obstruction. We present our experience with patients who had a previous VSARR or stentless bio-ARR and underwent ViV-TAVR to repair a degenerated aortic valve with combined valvular disease, aortic insufficiency and aortic stenosis. Methods In this retrospective data review, we identified and analyzed consecutive patients with a previous VSARR or stentless bio-ARR who underwent ViV-TAVR between December 1, 2014 and August 31, 2019. Results ViV-TAVR was performed in twelve high-risk patients with previous VSARR or bio-ARR during the study period. Of these, seven received Medtronic Freestyle porcine stentless bioprosthetic aortic roots, three received homograft aortic roots, one underwent a Ross procedure and one underwent VSARR. ViV-TAVR restored satisfactory valve function in all patients, and technical success was 100%. No patient had more than mild regurgitation after implantation. No thirty-day mortality was seen. One patient had major bleeding after transapical access, one patient had a transient ischemic stroke, and one patient needed permanent pacemaker implantation. At a median last follow-up of 21.5 months (interquartile range, 9.0-69.0 months), all patients remained alive and had satisfactory valve function. Conclusions In this study, ViV-TAVR was a clinically effective option for treating patients with a failed stentless bio-ARR or previous VSARR. Short-term and intermediate-term results after these procedures were favorable. These findings may have important implications for treating high-risk patients with structural aortic root deterioration and call for better transcatheter heart valves that are suitable for treating aortic insufficiency.
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Affiliation(s)
- Davut Cekmecelioglu
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA
| | - Kathryn G Dougherty
- Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA
| | - Subhasis Chatterjee
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA.,Division of General Surgery, Michael E. DeBakey Department of Surgery, Baylor College Medicine, Houston, Texas, USA
| | - Susan Y Green
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Office of Surgical Research, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Guilherme V Silva
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jose G Díez
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Department of Cardiology, Texas Heart Institute, Houston Texas, USA
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.,Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute and CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Texas, USA
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20
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Lee G, Ouzounian M, Tam DY. Commentary: What Happens to the Aorta in Bicuspid Aortic Valve Disease? Semin Thorac Cardiovasc Surg 2021; 34:868-869. [PMID: 34597793 DOI: 10.1053/j.semtcvs.2021.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Grace Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Maral Ouzounian
- Division of Cardiac Surgery, Department of Surgery, Peter Munk Cardiac Centre, University of Toronto, Toronto, Ontario, Canada
| | - Derrick Y Tam
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada.
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Glower DD. Bicuspid aortic valve repair: An ongoing struggle in material science. J Card Surg 2021; 36:4652-4653. [PMID: 34558108 DOI: 10.1111/jocs.16002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Techniques and results of aortic valve repair remain challenging. AIMS Safari et al. seek to improve aortic valve repair by either aortic patching or valve sparing root replacement. MATERIALS AND METHODS The results of bicuspid aortic valve (BAV) repair in 142 patients were examined withor without valve sparing root replacement. RESULTS Isolated BAV repair with or without valve sparing root replacement provided goodclinical outcomes with relatively low reoperation rate and durable valve function. DISCUSSION While clinical outcome from BAV repair was generally good, the authors have stopped pericardial patch augmentation of BAV leaflets due to suboptimal durability. CONCLUSION Thelack of a durable valve patch material and the modest durability of BAV repairin general point out that aortic valve repair remains an ongoing struggle inmaterial science.
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Safari M, Monsefi N, Karimian-Tabrizi A, Miskovic A, Van Linden A, Zacek P, Moritz A, Walther T, Holubec T. Longer-term outcomes after bicuspid aortic valve repair in 142 patients. J Card Surg 2021; 36:4645-4651. [PMID: 34547142 DOI: 10.1111/jocs.16006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/22/2021] [Accepted: 09/06/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the longer-term results of bicuspid aortic valve (BAV) repair with or without aortic root replacement. METHODS From 1999 to 2017, 142 patients with or without aortic root dilatation who underwent repair of a regurgitant BAV were included in the study. Ninety-four patients underwent isolated BAV repair (Group 1; median age 43 years) and 48 patients underwent valve-sparing aortic root replacement plus BAV repair (aortic valve reimplantation-Group 2; median age 48 years). Median clinical follow-up time was 5.9 years (range 0.5-15) in Group 1 and 3 years (range 0.5-16) in Group 2, respectively. RESULTS In-hospital mortality was 1% in Group 1, and 2% in Group 2 (p = .6). The 5- and 10-year survival was 93 ± 2.9% and 81 ± 5.8% in Group 1 and 96 ± 3.1% and 96 ± 3.1% in Group 2, respectively (p = .31). Eleven patients of Group 1 (1.7%/patient-year) and five patients of Group 2 (2.2%/patient-year) underwent reoperation of the aortic valve (p = .5). The 5- and 10-year freedom from reoperation were 93.0 ± 2.1% and 77.1 ± 7.1% in Group 1 and 93.0 ± 5.0% and 76.7 ± 9.6% in Group 2 (p = .83), respectively. At the latest follow-up, only two patients of Group 1 and 1 patient of Group 2 had AV regurgitation = 2° (p = .7). The cumulative linearized incidence of all valve-related complications (bleeding, stroke, endocarditis, and reoperation) was 2.9%/patient-year in Group 1% and 4%/patient-year in Group 2, respectively (p = .6). CONCLUSIONS Isolated BAV repair and combined aortic valve reimplantation plus BAV repair provide good clinical longer-term outcomes with relatively low reoperation rate and durable valve function.
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Affiliation(s)
- Mojyan Safari
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Nadejda Monsefi
- Department of Cardiac Surgery, University Hospital Bonn, Bonn, Germany
| | - Afsaneh Karimian-Tabrizi
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Alexandra Miskovic
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Arnaud Van Linden
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Pavel Zacek
- Department of Cardiac Surgery, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove and Charles University, Hradec Kralove, Czech Republic
| | - Anton Moritz
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Thomas Walther
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
| | - Tomas Holubec
- Department of Cardiovascular Surgery, University Hospital Frankfurt and Johann Wolfgang Goethe University Frankfurt, Frankfurt, Germany
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Early results after aortic annuloplasty with a complete external Dacron band. Gen Thorac Cardiovasc Surg 2021; 70:329-336. [PMID: 34542798 PMCID: PMC8930909 DOI: 10.1007/s11748-021-01695-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 09/04/2021] [Indexed: 10/29/2022]
Abstract
OBJECTIVE This study evaluates the early results of our initial experience with aortic annuloplasty using a complete external Dacron band in the setting of type Ic or type II aortic regurgitation (AR). METHODS From May 2017 to August 2019, 16 patients (88% bicuspid aortic valves, no patients with connective tissue disorders) underwent aortic annuloplasty with an external complete Dacron band. Clinical and echocardiographic follow-up was 100% complete. Clinical and echocardiographic follow-up averaged 24.4 ± 9.3 and 15.1 ± 8.3 months, respectively. RESULTS Mean cardiopulmonary and cross-clamp times were 105 ± 15 (72-127) and 86 ± 15 (51-113) min, respectively. Early and late mortality was 0%, with no incidents of endocarditis or cerebrovascular events during the follow-up. Two patients were re-operated during the follow-up, one due recurrent aortic regurgitation (12 months after the first operation) yielding a freedom from reoperation due to AR at 1 year and 3 years of 100% ± 0% and 93.3% ± 5.7%, respectively. Based on the latest echocardiogram, five patients had either none or trivial AR, six had mild AR, and three had mild-to-moderate AR. CONCLUSIONS The early clinical and echocardiographic results after using a complete external Dacron band are promising; however, more data and longer follow-up are needed to determine its role in annular management during aortic valve repair.
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Vervoort D, El-Hamamsy I, Chu MWA, Peterson MD, Ouzounian M. The Ross procedure and valve-sparing root replacement procedures in the adult patient: do guidelines follow the evidence? Ann Cardiothorac Surg 2021; 10:433-443. [PMID: 34422555 DOI: 10.21037/acs-2021-rp-24] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 04/15/2021] [Indexed: 12/16/2022]
Abstract
Prosthetic aortic valve replacements have long been the mainstay of valvular surgery due to their favorable outcomes and low operative complexity. Yet, mechanical valves require lifelong anticoagulation, whereas bioprosthetic valves increase the risk for earlier and more frequent reoperation. Alternative reconstructive techniques have been proposed to address these challenges. These include valve-sparing root replacement procedures if the native aortic valve can be salvaged, and the Ross procedure, which nearly eliminates prosthetic valve-related thromboembolism, anticoagulation-related hemorrhage and endocarditis. Both procedures are technically more complex and thus subject to surgeons' volume and expertise compared to conventional aortic valve replacements. However, they are associated with more favorable outcomes compared to aortic valve replacements if performed by experienced surgeons, especially in younger patients. Nevertheless, despite the growing high-quality literature supporting both procedures, existing multi-society guidelines fail to acknowledge the strength of evidence in support of valve-sparing root replacement procedures and the Ross procedure. In this review, we summarize the existing long-term evidence for the use of each procedure, describe the current guidelines for the treatment of aortic valve pathology, and propose the reevaluation of guidelines based on the available clinical evidence.
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Affiliation(s)
- Dominique Vervoort
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ismail El-Hamamsy
- Department of Cardiovascular Surgery, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, USA
| | - Michael W A Chu
- Division of Cardiac Surgery, Western University, London, Canada
| | - Mark D Peterson
- Division of Cardiovascular Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Maral Ouzounian
- Division of Cardiovascular Surgery, University of Toronto, Toronto, Ontario, Canada
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Tamer S, Mastrobuoni S, Lemaire G, Jahanyar J, Navarra E, Poncelet A, Astarci P, El Khoury G, de Kerchove L. Two decades of valve-sparing root reimplantation in tricuspid aortic valve: impact of aortic regurgitation and cusp repair. Eur J Cardiothorac Surg 2021; 59:1069-1076. [PMID: 33332548 DOI: 10.1093/ejcts/ezaa427] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/05/2020] [Accepted: 10/26/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES Our goal was to analyse the influence of preoperative aortic regurgitation (AR) on the necessity of cusp repair during valve-sparing reimplantation (VSR). We focused on patients with tricuspid aortic valves (TAV) and evaluated the impact of AR and cusp repair on long-term outcomes. METHODS From March 1998 to December 2018, a total of 512 consecutive patients underwent VSR at our institution; of these, 303 had a TAV. The mean age was 53 ± 15 years, and the median follow-up was 6.12 years. The rate and type of cusp repair were analysed based on preoperative AR. Time-to-event analysis was performed, as well as risk of death, reoperation and AR recurrence. RESULTS Cusp repair was necessary in 168 (55.4%) patients; the rate rose significantly as AR grade increased (P < 0.001). In-hospital mortality was 1% (n = 3). At 5 and 10 years, overall survival was 92 ± 2% and 75 ± 5%, respectively. Freedom from valve reoperation was 95 ± 2% and 90 ± 3%. Freedom from AR >2+ and AR >1+ at 10 years was 88 ± 4% and 70.4 ± 4.6%, respectively. Independent predictors of death included age, New York Heart Association functional class and type-A aortic dissection. Predictors of AR greater than mild included previous cardiac surgery and severe preoperative AR. CONCLUSION In patients with TAV receiving VSR, the necessity of cusp repair increased with the degree of preoperative AR. Preoperative AR and cusp repair do not impact long-term survival and aortic valve reoperation, but severe preoperative AR and multiple cusp repair increase the risk of recurrent moderate-to-severe AR. Overall, cusp repair seems to attenuate the negative impact of preoperative AR for at least 1 decade in a majority of patients.
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Affiliation(s)
- Saadallah Tamer
- Cardiovascular and Thoracic Surgery Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Stefano Mastrobuoni
- Cardiovascular and Thoracic Surgery Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Guillaume Lemaire
- Anesthesiology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Jama Jahanyar
- Cardiovascular and Thoracic Surgery Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Emiliano Navarra
- Cardiovascular and Thoracic Surgery Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Alain Poncelet
- Cardiovascular and Thoracic Surgery Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Parla Astarci
- Cardiovascular and Thoracic Surgery Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Gebrine El Khoury
- Cardiovascular and Thoracic Surgery Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Laurent de Kerchove
- Cardiovascular and Thoracic Surgery Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Beckmann E, Martens A, Krüger H, Korte W, Kaufeld T, Stettinger A, Haverich A, Shrestha ML. Aortic valve-sparing root replacement in patients with bicuspid aortic valve: long-term outcome with the David I procedure over 20 years. Eur J Cardiothorac Surg 2021; 58:86-93. [PMID: 32243510 DOI: 10.1093/ejcts/ezaa083] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 12/25/2019] [Accepted: 01/09/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Aortic valve-sparing root replacement is an excellent treatment option for patients with intact tricuspid aortic valves. However, the durability in patients with bicuspid aortic valves is still a matter of debate. The aim of this study was to analyse the short- and long-term outcomes in patients with bicuspid aortic valves. METHODS Between July 1993 and October 2015, a total of 582 patients underwent the David I procedure, 50 of whom had a bicuspid aortic valve. In these patients, the mean age was 46 ± 13 years, and 80% (n = 40) were men. Follow-up was complete for 100% of patients and comprised a total of 552 patient-years with a mean follow-up time of 11 ± 5.2 years. RESULTS In addition to the David procedure, cusp plication was performed in 34% (n = 17) of patients and commissure repair in 8% (n = 4) of patients. There were no in-hospital deaths, and 1 patient (2%) had a perioperative stroke. The 1-, 5-, 10- and 20-year survival rates of patients after discharge were 98%, 94%, 88% and 84%, respectively. The rates for freedom from valve-related reoperation at 1, 5, 10 and 20 years after initial surgery were 98%, 88%, 79% and 74%, respectively. Long-term freedom from reoperation was comparable to that of patients with tricuspid aortic valves (P = 0.2). CONCLUSIONS The David procedure has excellent short-term results in patients with a bicuspid aortic valve. In this study, the long-term durability of reimplanted bicuspid aortic valves was comparable to that of tricuspid valves. However, careful patient selection might have contributed to this, and further studies might be needed to definitely clarify this issue.
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Affiliation(s)
- Erik Beckmann
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Andreas Martens
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Heike Krüger
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Wilhelm Korte
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tim Kaufeld
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Alissa Stettinger
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Axel Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Malakh Lal Shrestha
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
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Valve Sparing Root Replacement versus Bio-Bentall: Inverse Propensity Weighting of 796 Patients. Ann Thorac Surg 2021; 113:1529-1535. [PMID: 34116001 DOI: 10.1016/j.athoracsur.2021.05.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/22/2021] [Accepted: 05/11/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND This large cohort, single center study aims to compare the 10-year survival and freedom from aortic valve reintervention between valve sparing root replacement (VSRR) and bioprosthetic Bentall (bio-Bentall). METHODS All patients undergoing elective VSRR or bio-Bentall for aortic root aneurysm between March 2005 through October 2019 were retrospectively reviewed (n=796 [VSRR = 360]). Inverse probability of treatment weighting (IPTW) balanced clinical variables between groups. Mean follow-up was 58.0 +/- 45.4 (range 0-167) months. RESULTS After IPTW adjustment, 10-year survival did not differ between groups (VSRR: 87.0% vs bio-Bentall: 92.7%, p=0.780). Cumulative incidence of aortic valve reintervention was 5.9% for VSRR (95% CI, 2.9%-10.4%) and 10.6% for bio-Bentall (95% CI, 6.2%-16.4%, p=0.798). Fine and Gray computing risk regression model identified age at surgery (sHR 0.97, 95% CI, 0.95-0.99, p=0.015), body surface area (sHR 6.21, 95% CI, 1.97-19.59, p=0.002) and bicuspid aortic valve (sHR 2.15, 95% CI, 1.04-4.44, p =0.038) as independently associated with aortic valve reintervention. For patients ≤50-year-old, cumulative incidence of aortic valve reintervention was 16.2% for VSRR (95% CI, 7.0%-28.8%) and 17.8% for bio-Bentall (95% CI, 6.9%-32.8%)(p=0.363). CONCLUSIONS VSRR and bio-Bentall show similar excellent survival and freedom from aortic reintervention rates up to 10 years; however, a durable valve solution for young patients with bicuspid aortic valve remains a challenge.
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Danial P, Neily A, Pontailler M, Gaudin R, Khraiche D, Osborne-Pellegrin M, Vouhe P, Raisky O. Ross procedure or complex aortic valve repair using pericardium in children: A real dilemma. J Thorac Cardiovasc Surg 2021; 163:1180-1191.e6. [PMID: 33820635 DOI: 10.1016/j.jtcvs.2021.02.093] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 02/23/2021] [Accepted: 02/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Difficult to repair aortic valve lesions, requiring the use of a valve substitute, remain controversial in the face of the Ross procedure, despite undeniable technical advances. This study was undertaken to compare midterm outcomes of children treated using the Ross procedure or aortic valvuloplasty for complex aortic valve lesions. METHODS Between January 2006 and December 2017, 126 patients aged younger than 18 years were treated for complex aortic stenosis and/or aortic insufficiency and were included in this retrospective study. Only aortic valve lesions requiring repair with an autologous or heterologous pericardial patch were considered complex lesions. Propensity score framework analyses were used to compare outcomes of the Ross and aortic valvuloplasty groups while controlling for confounders. RESULTS Among the 126 patients with complex aortic valve lesions, propensity score matching selected 34 unique pairs of patients with similar characteristics. Survival (aortic valvuloplasty, 94.1%; Ross, 91%; P = .89), freedom from overall reintervention (aortic valvuloplasty, 50.1%; Ross, 69%; P = .32), and freedom from infective endocarditis at 8 years (aortic valvuloplasty, 100%; Ross, 85.9%; P = .21) were similar. However, freedom from reintervention in the left ventricular outflow tract at 8 years was lower after aortic valvuloplasty than after the Ross procedure (50.1% vs 100%, respectively; P = .001). CONCLUSIONS Aortic valvuloplasty and the Ross procedure yielded similar 8-year outcomes regarding death, reoperation, and infective endocarditis although aortic valvuloplasty tended to be associated with fewer cases of infective endocarditis. Aortic valvuloplasty using a pericardial patch can be chosen as a first-line strategy for treating complex aortic valve lesions and might offer the possibility of a later Ross procedure.
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Affiliation(s)
- Pichoy Danial
- Pediatric Cardiac Surgery, Necker Sick Children's Hospital and Paris University, Paris, France; Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Asma Neily
- Pediatric Cardiac Surgery, Necker Sick Children's Hospital and Paris University, Paris, France
| | - Margaux Pontailler
- Pediatric Cardiac Surgery, Necker Sick Children's Hospital and Paris University, Paris, France
| | - Régis Gaudin
- Pediatric Cardiac Surgery, Necker Sick Children's Hospital and Paris University, Paris, France
| | - Diala Khraiche
- Pediatric Cardiac Surgery, Necker Sick Children's Hospital and Paris University, Paris, France
| | - Mary Osborne-Pellegrin
- Department of Cardiovascular and Thoracic Surgery, Institute of Cardiology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne University, Paris, France
| | - Pascal Vouhe
- Pediatric Cardiac Surgery, Necker Sick Children's Hospital and Paris University, Paris, France
| | - Olivier Raisky
- Pediatric Cardiac Surgery, Necker Sick Children's Hospital and Paris University, Paris, France.
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Ntinopoulos V, Papadopoulos N, Odavic D, Haeussler A, Loeblein H, Dzemali O. Aortic Root Replacement with Reimplantation of the Aortic Valve: A Low-Volume Center Experience. Thorac Cardiovasc Surg 2021; 70:297-305. [PMID: 33601468 DOI: 10.1055/s-0041-1723844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Most data after root replacement with reimplantation of the aortic valve originate from high-volume centers. This raises concerns about the generalizability of these data and the reproducibility of this complex procedure. Aim of this study is to assess the perioperative and midterm outcomes of this procedure in a low-volume center. METHODS We performed a retrospective analysis of the data of 72 patients, who underwent root replacement with reimplantation of the aortic valve in a single center between 2011 and 2020. Time to event analysis was performed with Kaplan-Meier curves. Longitudinal analysis of serial echocardiographic data was performed with a mixed-effects ordinal logistic regression model. RESULTS In-hospital mortality was 1.4%, with absence of any neurological events during the perioperative period. At midterm follow-up, two further patients died. Overall survival rates at 1 and 5 years were 98.5% (95% confidence interval [CI]: 97-100%) and 96.3% (95% CI: 93.8-98.8%), respectively. During follow-up, five patients (6.9%) required reoperation on the aortic valve. The incidence of moderate and severe aortic regurgitation at 5 years was 6.6% (95% CI: 2.4-13.6%) and 0.6% (95% CI: 0.1-3.2%), respectively. Mild aortic regurgitation at hospital discharge (p < 0.001) and cusp plication (p = 0.0121) were associated with a higher incidence of moderate or severe aortic regurgitation at follow-up. CONCLUSION Reimplantation of the aortic valve is safe and feasible even in a low-volume center. Mortality, freedom from reoperation, and incidence of moderate or severe aortic regurgitation at follow-up are comparable to those of high-volume centers.
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Affiliation(s)
| | | | - Dragan Odavic
- Department of Cardiac Surgery, Municipal Hospital Triemli, Zurich, Switzerland
| | - Achim Haeussler
- Department of Cardiac Surgery, Municipal Hospital Triemli, Zurich, Switzerland
| | - Helen Loeblein
- Department of Cardiac Surgery, Municipal Hospital Triemli, Zurich, Switzerland
| | - Omer Dzemali
- Department of Cardiac Surgery, Municipal Hospital Triemli, Zurich, Switzerland
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Kalra K, Wagh K, Wei JW, McPherson L, Binongo JN, Leshnower BG, Chen EP. Regurgitant Bicuspid Aortopathy: Is Valve-Sparing Root Replacement Equivalent to Bentall Procedure? Ann Thorac Surg 2020; 112:737-745. [PMID: 33197424 DOI: 10.1016/j.athoracsur.2020.08.074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 08/10/2020] [Accepted: 08/31/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Repair of aortic root aneurysms with nonstenotic bicuspid valves (NS-BAVs) is achieved either with valve-sparing root replacement (VSRR) or conventional Bentall procedure (ROOT). Procedural and long-term outcomes comparing these 2 techniques are sparse and need investigation. METHODS From March 2004 to January 2019, 158 patients with an aortic root aneurysm and NS-BAV underwent VSRR (n = 78, 49.3%) or ROOT (n = 80, 50.6%). VSRR involved optional aortic valve repair (n = 47, 60%), and ROOT was performed with bioprosthetic (81.3%) or mechanical valve replacement (18.7%). Procedural and postoperative outcomes were obtained, and univariate and Kaplan-Meier analyses were performed. RESULTS VSRR patients were younger (42.7 ± 12.0 years of age) than ROOT (54.8 ± 13.6 years of age) (P < .001). Cardiopulmonary bypass (CPB) and cross-clamp duration were longer in VSRR (CPB: 228.0 ± 39.1 minutes; cross-clamp: 200.1 ± 36.2 minutes) compared with ROOT (CPB: 199.5 ± 55 minutes; cross-clamp: 170.3 ± 39.5 minutes) (P < .001). Postoperative stroke, renal failure, pneumonia, and reoperation for bleeding were similar, but postoperative atrial and ventricular arrhythmias was lower in VSRR (15% vs 42%; P < .001). Length of stay and 30-day mortality were similar. At discharge, none had greater than trivial aortic insufficiency. Long-term 10-year survival and incidence of moderate-severe aortic insufficiency, aortic stenosis, and reoperation were equivalent between groups. CONCLUSIONS Surgery for aortopathy associated with NS-BAV is safe and effective with either VSRR or ROOT. Despite its complexity, VSRR should be considered in the surgical treatment of this population.
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Affiliation(s)
- Kanika Kalra
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Kaustubh Wagh
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jane W Wei
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - LaRonica McPherson
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Jose N Binongo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Bradley G Leshnower
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Edward P Chen
- Division of Cardiothoracic Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, Georgia.
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Álvarez-Cabo R, Vigil-Escalera C, Escalera AE, Meana B, Martín M, de la Hera JM, Salmerón C, Díaz R, Hernández-Vaquero D, Meca J, Mencía P, Zabala M, Callejo F, Llosa JC, Morales C, Silva J. Cirugía conservadora valvular aórtica. Resultados a 9 años. CIRUGIA CARDIOVASCULAR 2020. [DOI: 10.1016/j.circv.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Abstract
PURPOSE OF REVIEW Until the year 2000, the publications concerning aortic valve sparing (AVS) did not exceed 20 articles; in the following years almost 300 publications have appeared. Over 35 years from the introduction of valve sparing techniques and 500 years after the death of Leonardo da Vinci, this review highlights the significant steps in modern imaging techniques and the excellent clinical results in the field of reconstructive aortic root surgery. RECENT FINDINGS AVS operations underwent significant modifications over the last few years making it reproducible with satisfactory outcomes. The extraordinary potential of imaging opens new boundless horizons in the perspective of an increasingly patient-tailored surgical planning. The basic surgical concepts include the preservation and resuspension of the aortic valve in a near-normal environment (with the creation of functionally suited neo-aortic sinuses) and the re-establishment of a normal relationship of the aortic root components. SUMMARY Today is possible to perform a reimplantation procedure with the creation of neo-sinuses or a remodeling procedure with the addition of annular support. Both procedures can now guarantee an anatomical root reconstruction and an increased long-term durability. AVS operations have become established alternatives to Bentall procedures for patients with aortic root pathology, especially in young patients.
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Álvarez-Cabo R, Vigil-Escalera C, Escalera AE, Meana Fernández B, Martín M, Salmerón C, Díaz Méndez R, Hernández-Vaquero D, Meca J, Mencía P, Zabala Morales M, Callejo Magaz F, Llosa JC, Morales Pérez C, Silva Guisasola J. Reparación valvular aórtica bicúspide. Resultados. CIRUGIA CARDIOVASCULAR 2020. [DOI: 10.1016/j.circv.2020.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Zhu Y, Imbrie-Moore AM, Park MH, Paulsen MJ, Wang H, MacArthur JW, Woo YJ. Ex Vivo Analysis of a Porcine Bicuspid Aortic Valve and Aneurysm Disease Model. Ann Thorac Surg 2020; 111:e113-e115. [PMID: 32663472 DOI: 10.1016/j.athoracsur.2020.05.086] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/13/2020] [Indexed: 12/28/2022]
Abstract
We identified an extremely rare congenital porcine type 0 lateral bicuspid aortic valve from a fresh porcine heart. Using a 3-dimensionally printed ex vivo left heart simulator, we analyzed valvular hemodynamics at baseline, in an aortic aneurysm disease model, and after valve-sparing root replacement. We showed that bicuspid aortic valve regurgitation due to aortic aneurysm can be successfully repaired without significant hemodynamic impairment using the valve-sparing root replacement technique in an individualized approach. Our results provide direct hemodynamic evidence supporting the use of valve-sparing root replacement for patients with bicuspid aortic valve regurgitation.
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Affiliation(s)
- Yuanjia Zhu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California; Department of Bioengineering, Stanford University, Stanford, California
| | - Annabel M Imbrie-Moore
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California; Department of Mechanical Engineering, Stanford University, Stanford, California
| | - Matthew H Park
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California; Department of Mechanical Engineering, Stanford University, Stanford, California
| | - Michael J Paulsen
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Hanjay Wang
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - John W MacArthur
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California; Department of Bioengineering, Stanford University, Stanford, California.
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Etz CD, Haunschild J, Girdauskas E, Della Corte A, Fedak PWM, Schäfers HJ, Sundt TM, Borger MA. Surgical management of the aorta in BAV patients. Prog Cardiovasc Dis 2020; 63:475-481. [PMID: 32640281 DOI: 10.1016/j.pcad.2020.06.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/25/2020] [Indexed: 12/12/2022]
Abstract
Patients with a bicuspid aortic valve (BAV) frequently develop aneurysms of the aortic root and tubular ascending aorta. Aneurysms of the aortic arch, in the absence of concomitant aortopathies, are much less common. According to the 2018 American Association of Thoracic Surgery consensus guidelines on BAV-related aortopathy, prophylactic surgical aortic repair / replacement is recommended starting at a maximum aortic diameter of 50 mm in patients with risk factors. Concomitant aortic surgery is also recommended at an aortic diameter of 45 mm in those patients with other indications for cardiac surgery (most commonly aortic valve procedures). The ultimate goal of prophylactic aortic surgery is the prevention of aortic catastrophes, e.g. aortic rupture or acute aortic dissection, which are associated with high morbidity and mortality. The surgical technique used - in elective and emergency cases - depends on the involvement and nature of the aortic valve disease, as well as the extent of aortic aneurysm formation. The current review focusses on the surgical management of the aortic root, tubular ascending aorta, and proximal aortic arch in BAV patients. Despite the abovementioned recommendations, many BAV patients develop acute aortic syndromes below the recommended aortic diameter thresholds. Further research is therefore required in order to identify high-risk BAV subgroups that would benefit from earlier surgical repair.
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Affiliation(s)
- Christian D Etz
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | | | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany
| | - Alessandro Della Corte
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Paul W M Fedak
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Libin Cardiovascular Institute, Calgary, Canada
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Thoralf M Sundt
- Division of Cardiac Surgery, Massachusetts General Hospital, Boston, MA, United States
| | - Michael A Borger
- University Clinic of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.
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Yokawa K, Henmi S, Nakai H, Yamanaka K, Omura A, Inoue T, Okita Y, Okada K. Mid-term outcomes of valve-sparing root reimplantation with leaflet repair. Eur J Cardiothorac Surg 2020; 58:138-144. [PMID: 32187353 DOI: 10.1093/ejcts/ezaa058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/27/2020] [Accepted: 01/31/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Valve repair for aortic insufficiency (AI) requires a tailored surgical approach determined by the leaflet and aortic disease. In this study, we used a repair-oriented system for the classification of AI, and we elucidated long-term outcomes of aortic root reimplantation with this classification system. METHODS From 1999 to 2018, a total of 197 patients underwent elective reimplantation (mean age: 52.7 ± 17.7 years; 80% male). The aortic valve was tricuspid in 143 patients, bicuspid in 51 patients and quadricuspid in 3 patients. A total of 93 patients had type I AI (aortic dilatation), 57 patients had type II AI (cusp prolapse) and 47 patients had type III AI (restrictive). In total, 104 of the 264 patients (39%) had more than 1 identified mechanism. RESULTS In-hospital mortality was 0.5% (1/197). Mid-term follow-up (mean follow-up duration: 5.5 years) revealed a late mortality rate of 4.2% (9/197). Aortic valve reoperation was performed on 16 patients (8.0%). Rates of freedom from aortic valve replacement and freedom from aortic valve-related events at 10 years of follow-up were 87.0 ± 4.0% and 60.6 ± 6.0%, respectively; patients with type Ib AI (98.3 ± 1.7%; 80.7 ± 7.5%) had better outcomes than patients with type III AI (59.6 ± 15.6%; 42.2 ± 13.1%, P = 0.01). In patients with types II and III AI who had bicuspid aortic valves, rates of freedom from aortic valve-related events at 5 years of follow-up were 95.2 ± 4.7% and 71.7 ± 9.1%, respectively (P = 0.03). CONCLUSIONS This repair-oriented system for classifying AI could help to predict the durable aortic valve repair techniques. Patient selection according to the classification is particularly important for long-term durability. CLINICAL TRIAL REGISTRATION NUMBER B190050.
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Affiliation(s)
- Koki Yokawa
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Soichiro Henmi
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidekazu Nakai
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Katsuhiro Yamanaka
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsushi Omura
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Inoue
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Okita
- Department of Cardiovascular Surgery, Takatsuki Hospital, Osaka, Japan
| | - Kenji Okada
- Department of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Yates MT, Jahangiri M. How To Assess the Evidence for Aortic Valve Repair? Ann Thorac Surg 2020; 110:1973-1974. [PMID: 32504606 DOI: 10.1016/j.athoracsur.2020.04.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Martin T Yates
- Department of Cardiac Surgery, St. George's Hospital, London, United Kingdom
| | - Marjan Jahangiri
- Department of Cardiac Surgery, St. George's Hospital, Blackshaw Rd, London SW17 0QT, United Kingdom.
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David TE. Commentary: Are the results of reimplantation of the aortic valve the same for bicuspid and tricuspid valves? J Thorac Cardiovasc Surg 2020; 163:64-65. [DOI: 10.1016/j.jtcvs.2020.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 12/29/2022]
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Hui DS, de la Cruz KI. Commentary: Valve-sparing root replacement in bicuspid valves-more than technique. J Thorac Cardiovasc Surg 2020; 161:481-482. [PMID: 32067785 DOI: 10.1016/j.jtcvs.2019.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 12/06/2019] [Accepted: 12/07/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Dawn S Hui
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Tex.
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Greason KL. Commentary: Valve-sparing root replacement in patients with bicuspid versus tricuspid aortic valves: Is the comparison apples to apples? J Thorac Cardiovasc Surg 2019; 158:12-13. [PMID: 30655062 DOI: 10.1016/j.jtcvs.2018.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 11/12/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
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Girardi LN. Commentary: Valve-sparing root replacement in patients with bicuspid aortic valves: Long-term data are driving patient selection. J Thorac Cardiovasc Surg 2018; 158:10-11. [PMID: 30527781 DOI: 10.1016/j.jtcvs.2018.10.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 10/21/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY.
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