Christophe de Meester1, Agnès Pasquet1, Bernhard L Gerber1, David Vancraeynest1, Philippe Noirhomme2, Gébrine El Khoury2, Jean-Louis J Vanoverschelde3. 1. Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium; Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium. 2. Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium; Division of Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium. 3. Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium; Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium. Electronic address: jean-louis.vanoverschelde@uclouvain.be.
Abstract
BACKGROUND: For patients with aortic regurgitation (AR), aortic valve (AV) repair represents an attractive alternative to AV replacement (AVR), because it does not expose patients to the risk of prosthetic valve complications. Although the durability of AV repair has been documented, its prognosis has not yet been compared with prognosis of AVR. METHODS: We performed a propensity score analysis to match patients who underwent surgical correction of severe AR by either AVR or AV repair between 1995 and 2012. After matching, 44 pairs of patients were compared regarding baseline characteristics; overall survival; operative survival; cardiac events, including reoperations; recurrent AR; and New York Heart Association functional class at final follow-up. RESULTS: Operative mortality was similar in the AV repair and AVR groups (2% vs 5%; P=.56). Kaplan-Meier survival analysis indicated a significantly better overall 9-year survival after AV repair than after AVR (87% vs 60%; P=.007). Cox proportional survival analysis demonstrated that the choice of treatment was an independent predictor of postoperative survival. Finally, AV repair resulted in a slight increase, albeit not statistically significant, in reoperation rate (8% vs 2%; log rank P=.35). CONCLUSIONS: AV repair significantly improves postoperative outcomes in patients with AR and whenever feasible should probably be the preferred mode of surgical correction.
BACKGROUND: For patients with aortic regurgitation (AR), aortic valve (AV) repair represents an attractive alternative to AV replacement (AVR), because it does not expose patients to the risk of prosthetic valve complications. Although the durability of AV repair has been documented, its prognosis has not yet been compared with prognosis of AVR. METHODS: We performed a propensity score analysis to match patients who underwent surgical correction of severe AR by either AVR or AV repair between 1995 and 2012. After matching, 44 pairs of patients were compared regarding baseline characteristics; overall survival; operative survival; cardiac events, including reoperations; recurrent AR; and New York Heart Association functional class at final follow-up. RESULTS: Operative mortality was similar in the AV repair and AVR groups (2% vs 5%; P=.56). Kaplan-Meier survival analysis indicated a significantly better overall 9-year survival after AV repair than after AVR (87% vs 60%; P=.007). Cox proportional survival analysis demonstrated that the choice of treatment was an independent predictor of postoperative survival. Finally, AV repair resulted in a slight increase, albeit not statistically significant, in reoperation rate (8% vs 2%; log rank P=.35). CONCLUSIONS: AV repair significantly improves postoperative outcomes in patients with AR and whenever feasible should probably be the preferred mode of surgical correction.
Authors: Nelleke M Korteland; Derya Top; Gerard J J M Borsboom; Jolien W Roos-Hesselink; Ad J J C Bogers; Johanna J M Takkenberg Journal: Interact Cardiovasc Thorac Surg Date: 2016-02-25
Authors: Gilson Soares Feitosa-Filho; José Maria Peixoto; José Elias Soares Pinheiro; Abrahão Afiune Neto; Afonso Luiz Tavares de Albuquerque; Álvaro César Cattani; Amit Nussbacher; Ana Amelia Camarano; Angela Hermínia Sichinels; Antonio Carlos Sobral Sousa; Aristóteles Comte de Alencar Filho; Claudia F Gravina; Dario Celestino Sobral Filho; Eduardo Pitthan; Elisa Franco de Assis Costa; Elizabeth da Rosa Duarte; Elizabete Viana de Freitas; Emilio Hideyuki Moriguchi; Evandro Tinoco Mesquita; Fábio Fernandes; Gilson Soares Feitosa; Humberto Pierre; Ilnei Pereira Filho; Izo Helber; Jairo Lins Borges; Jéssica Myrian de Amorim Garcia; José Antonio Gordillo de Souza; José Carlos da Costa Zanon; Josmar de Castro Alves; Kalil Lays Mohallem; Laura Mariana de Siqueira Mendonça Chaves; Lídia Ana Zytynski Moura; Márcia Cristina Amélia da Silva; Maria Alice de Vilhena Toledo; Maria Elisa Lucena Sales de Melo Assunção; Mauricio Wajngarten; Mauro José Oliveira Gonçalves; Neuza Helena Moreira Lopes; Nezilour Lobato Rodrigues; Paulo Roberto Pereira Toscano; Pedro Rousseff; Ricardo Antonio Rosado Maia; Roberto Alexandre Franken; Roberto Dischinger Miranda; Roberto Gamarski; Ronaldo Fernandes Rosa; Silvio Carlos de Moraes Santos; Siulmara Cristina Galera; Stela Maris da Silva Grespan; Teresa Cristina Rogerio da Silva; William Antonio de Magalhães Esteves Journal: Arq Bras Cardiol Date: 2019-06-06 Impact factor: 2.000
Authors: J Scott Rankin; Domenico Mazzitelli; Theodor J M Fischlein; Yeong-Hoon Choi; Diana Aicher; Lawrence M Wei; Vinay Badhwar Journal: JTCVS Tech Date: 2020-01-23