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El Mathari S, Boulidam N, de Heer F, de Kerchove L, Schäfers HJ, Lansac E, Twisk JWR, Kluin J. Surgical outcomes of aortic valve repair for specific aortic valve cusp characteristics; retraction, calcification, and fenestration. J Thorac Cardiovasc Surg 2023; 166:1627-1634.e3. [PMID: 37244390 DOI: 10.1016/j.jtcvs.2023.05.020] [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: 03/09/2023] [Revised: 05/02/2023] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVES We investigated the predictive value of aortic valve cusp retraction, calcification, and fenestration for aortic valvuloplasty feasibility. METHODS Multicenter data were collected for 2082 patients who underwent surgical aortic valvuloplasty or aortic valve replacement. The study population had retraction, calcification, or fenestration in at least one aortic valve cusp. Controls had normal or prolapsed cusps. RESULTS All cusp characteristics demonstrated significantly increased odds ratios [ORs] for switch to valve replacement. This effect was strongest for cusp retraction, followed by calcification and fenestration (OR, 25.14; P ≤ .001; OR, 13.50, P ≤ .001; OR, 12.32, P ≤ .001). Calcification and retraction displayed increased odds for developing grade 4 aortic regurgitation compared with grade 0 or 1 combined on average over time (OR, 6.67; P ≤ .001; OR, 4.13; P = .038). Patients with cusp retraction showed increased risk for reintervention at 1- and 2-year follow-up after aortic valvuloplasty (hazard ratio, 5.66; P ≤ .001; hazard ratio, 3.22, P = .007). Cusp fenestration was the only group showing neither an increased risk of postoperative severe aortic regurgitation (P = .57) or early reintervention (P = .88) compared with the control group. CONCLUSIONS Aortic valve cusp retraction, calcification, and fenestration were all related to increased rates of switch to valve replacement. Calcification and retraction were associated with recurrence of severe aortic regurgitation. Retraction was related to early reintervention. Fenestration was neither associated with recurrence of severe aortic regurgitation or reintervention. This indicates that surgeons are well able to distinguish aortic valve repair candidates in patients with cusp fenestration.
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Affiliation(s)
- Sulayman El Mathari
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.
| | - Noor Boulidam
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Frederiek de Heer
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Laurent de Kerchove
- Department of Cardiothoracic and Vascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Hans-Joachim Schäfers
- Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg, Germany
| | - Emmanuel Lansac
- Department of Cardiovascular and Thoracic Surgery, Pitié-Salpêtrière APHP Hospital, Paris, France
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Sá MPBO, Perazzo ÁM, Zhigalov K, Komarov R, Kadyraliev B, Enginoev S, Ennker J, Popov AF, Quarto C, Weymann A, Lima RC. Aortic Valve Neocuspidization with Glutaraldehyde-Treated Autologous Pericardium (Ozaki Procedure) - A Promising Surgical Technique. Braz J Cardiovasc Surg 2019; 34:610-614. [PMID: 31719012 PMCID: PMC6852454 DOI: 10.21470/1678-9741-2019-0304] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
In cases of aortic valve disease, prosthetic valves have been increasingly used
for valve replacement, however, there are inherent problems with prostheses, and
their quality in the so-called Third World countries is lower in comparison to
new-generation models, which leads to shorter durability. Recently,
transcatheter aortic valve replacement has been explored as a less invasive
option for patients with high-risk surgical profile. In this scenario, aortic valve neocuspidization (AVNeo) has emerged as another
option, which can be applied to a wide spectrum of aortic valve diseases.
Despite the promising results, this procedure is not widely spread among cardiac
surgeons yet. Spurred on by the last publications, we went on to write an
overview of the current practice of state-of-the-art AVNeo and its results.
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Affiliation(s)
- Michel Pompeu Barros Oliveira Sá
- Division of Cardiovascular Surgery, Pronto-Socorro Cardiológico de Pernambuco - Prof. Luiz Tavares, PROCAPE, Recife, Brazil.,University of Pernambuco Recife Brazil University of Pernambuco, UPE, Recife, Brazil.,Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute, FCM/ICB, Recife, Brazil
| | - Álvaro M Perazzo
- Division of Cardiovascular Surgery, Pronto-Socorro Cardiológico de Pernambuco - Prof. Luiz Tavares, PROCAPE, Recife, Brazil.,University of Pernambuco Recife Brazil University of Pernambuco, UPE, Recife, Brazil
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, Germany
| | - Roman Komarov
- Department of Cardiac Surgery, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Bakytbek Kadyraliev
- Department of Cardiac Surgery, E.A. Vagner Perm State Medical University, S.G. Sukhanov Federal Center of Cardiovascular Surgery, Perm, Russia
| | - Soslan Enginoev
- Department of Cardiac Surgery, Federal Center for Cardiovascular Surgery, Russia.,Astrakhan State Medical University, Astrakhan, Russia
| | - Jürgen Ennker
- School of Medicine, Faculty of Health, University of Witten Herdecke, Witten, Germany
| | - Aron Frederik Popov
- Department of Thoracic and Cardiovascular Surgery, University Medical Centre Tübingen, Tübingen, Germany
| | - Cesare Quarto
- Department of Cardiothoracic Surgery, Royal Brompton & Harefield NHS Trust, London, UK
| | - Alexander Weymann
- Department of Cardiac Surgery, European Medical School Oldenburg, Groningen, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Ricardo Carvalho Lima
- Division of Cardiovascular Surgery, Pronto-Socorro Cardiológico de Pernambuco - Prof. Luiz Tavares, PROCAPE, Recife, Brazil.,University of Pernambuco, UPE, Recife, Brazil.,Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute, FCM/ICB, Recife, Brazil
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