Emmanuel Lansac1, Olivier Bouchot2, Eric Arnaud Crozat3, Rachid Hacini3, Fabien Doguet4, Roland Demaria5, Alain Leguerrier6, Jerome Jouan7, Didier Chatel8, Stephane Lopez9, Thierry Folliguet10, Christophe Acar11, Pascal Leprince11, Thierry Langanay6, Oliver Jegaden12, Jean Paul Bessou4, Bernard Albat5, Christian Latremouille7, Jean-Noel Fabiani7, Georges Fayad13, Jean Pierre Fleury14, Blandine Pasquet15, Mathieu Debauchez16, Isabelle Di Centa17, Florence Tubach18. 1. Department of Cardiac Surgery, Institut Mutualiste Montsouris, Paris, France. Electronic address: emmanuel.lansac@imm.fr. 2. Department of Cardiac Surgery, CHU Le Bocage, Dijon, France. 3. Department of Cardiac Surgery, CHU A. Michallon, La Tronche, France. 4. Department of Cardiac Surgery, CHU Charles Nicolle, Rouen, France. 5. Department of Cardiac Surgery, CHU A. De Villeneuve, Montpellier, France. 6. Department of Cardiac Surgery, CHU Pontchaillou, Rennes, France. 7. Department of Cardiac Surgery, CHU Hopital Europeen Georges Pompidou, Paris, France. 8. Department of Cardiac Surgery, Clinique Saint Gatien, Tours, France. 9. Department of Cardiac Surgery, Institut Arnault Tzanck, Saint Laurent Du Var, France. 10. Department of Cardiac Surgery, Hopital Brabois, CHU Nancy, Nancy, France. 11. Department of Cardiac Surgery, CHU Pitié Salpetriere, Paris, France. 12. Department of Cardiac Surgery, Hopital Louis Pradel, CHU, Lyon, France. 13. Department of Cardiac Surgery, Centre Hospitalier Régional Universitaire de Lille, Lille, France. 14. Department of Cardiac Surgery, Clinique Belledone, Saint Martin d'Hères, France. 15. Assistance Publique Hôpitaux de Paris, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, Paris, France. 16. Department of Cardiac Surgery, Institut Mutualiste Montsouris, Paris, France. 17. Department of Vascular Surgery, Hopital Foch, Suresnes, France. 18. Assistance Publique Hôpitaux de Paris, Département d'Epidémiologie et Recherche Clinique, Hôpital Bichat, Paris, France; Paris Diderot University, Sorbonne Paris Cité, Paris, France.
Abstract
OBJECTIVE: The study objective was to compare the 30-day outcomes of a standardized aortic valve repair technique (REPAIR group) associating root remodeling with an expansible aortic ring annuloplasty versus mechanical composite valve and graft (CVG group) replacement in treating aortic root aneurysms. METHODS: A total of 261 consecutive patients with aortic root aneurysm were enrolled in this multicentric prospective cohort (131 in the CVG group, 130 in the REPAIR group) in 20 centers. The main end point is a composite criterion including mortality; reoperation; thromboembolic, hemorrhagic, or infectious events; and heart failure. Secondary end points were major adverse valve-related events. Crude and propensity score adjusted estimates are provided. RESULTS: The mean age was 56.1 years, and the valve was bicuspid in 115 patients (44.7%). The median (interquartile range) preoperative aortic insufficiency grade was 2.0 (1.0-3.0) in the REPAIR group and 3.0 (2.0-3.0) in the CVG group (P = .0002). Thirty-day mortality was 3.8% (n = 5) in both groups (P = 1.00). Despite a learning curve and longer crossclamp times for valve repair (147.7 vs 99.8 minutes, P < .0001), the 2 groups did not differ significantly for the main criterion (odds ratio, 1.31; 95% confidence interval, 0.72-2.40; P = .38) or 30-day mortality (odds ratio, 0.99; 95% confidence interval, 0.28-3053; P = .99), with a trend toward more frequent major adverse valve-related events in the CVG group (odds ratio, 2.52; 95% confidence interval, 0.86-7.40; P = .09). At discharge, 121 patients (96.8%) in the REPAIR group had grade 0 or 1 aortic insufficiency. CONCLUSIONS: A new standardized approach to valve repair, combining an expansible aortic annuloplasty ring with the remodeling technique, presented similar 30-day results to mechanical CVG with a trend toward reducing major adverse valve-related events. Analysis of late outcomes is in process for 3- and 10-year follow-ups.
OBJECTIVE: The study objective was to compare the 30-day outcomes of a standardized aortic valve repair technique (REPAIR group) associating root remodeling with an expansible aortic ring annuloplasty versus mechanical composite valve and graft (CVG group) replacement in treating aortic root aneurysms. METHODS: A total of 261 consecutive patients with aortic root aneurysm were enrolled in this multicentric prospective cohort (131 in the CVG group, 130 in the REPAIR group) in 20 centers. The main end point is a composite criterion including mortality; reoperation; thromboembolic, hemorrhagic, or infectious events; and heart failure. Secondary end points were major adverse valve-related events. Crude and propensity score adjusted estimates are provided. RESULTS: The mean age was 56.1 years, and the valve was bicuspid in 115 patients (44.7%). The median (interquartile range) preoperative aortic insufficiency grade was 2.0 (1.0-3.0) in the REPAIR group and 3.0 (2.0-3.0) in the CVG group (P = .0002). Thirty-day mortality was 3.8% (n = 5) in both groups (P = 1.00). Despite a learning curve and longer crossclamp times for valve repair (147.7 vs 99.8 minutes, P < .0001), the 2 groups did not differ significantly for the main criterion (odds ratio, 1.31; 95% confidence interval, 0.72-2.40; P = .38) or 30-day mortality (odds ratio, 0.99; 95% confidence interval, 0.28-3053; P = .99), with a trend toward more frequent major adverse valve-related events in the CVG group (odds ratio, 2.52; 95% confidence interval, 0.86-7.40; P = .09). At discharge, 121 patients (96.8%) in the REPAIR group had grade 0 or 1 aortic insufficiency. CONCLUSIONS: A new standardized approach to valve repair, combining an expansible aortic annuloplasty ring with the remodeling technique, presented similar 30-day results to mechanical CVG with a trend toward reducing major adverse valve-related events. Analysis of late outcomes is in process for 3- and 10-year follow-ups.
Authors: Maria Elena Soto; Eric Ochoa-Hein; Javier E Anaya-Ayala; Micaela Ayala-Picazo; Solange Gabriela Koretzky Journal: J Thorac Dis Date: 2021-08 Impact factor: 3.005
Authors: Clément Dubost; Jacques Tomasi; Antoine Ducroix; Kevin Pluchon; Pierre Escrig; Olivier Fouquet; Arthur Aupart; Alain Mirza; Imen Fellah; Eric Bezon; Christophe Baufreton; Jean Marc El Arid; Jean-Christian Roussel; Jean-Philippe Verhoye; Thomas Senage Journal: Interact Cardiovasc Thorac Surg Date: 2022-10-10