Marek J Jasinski1, Radoslaw Gocol2, Marcin Malinowski2, Damian Hudziak2, Piotr Duraj2, Marek A Deja2. 1. Department of Cardiac Surgery, Medical University of Silesia, School of Medicine, Katowice, Poland. Electronic address: marekjas@poczta.onet.pl. 2. Department of Cardiac Surgery, Medical University of Silesia, School of Medicine, Katowice, Poland.
Abstract
OBJECTIVES: Advantages of aortic valve repair and root reconstruction include maintenance of natural valve hemodynamic parameters and avoidance of prosthetic valve-related complications. However, general acceptance of valve reconstruction may be limited by paucity of long-term follow-up data from only a few centers. This report is intended to supplement existing outcome information for aortic valve repair. METHODS: Between 2003 and 2013, 200 consecutive patients (149 men, 51 women; mean age, 52.1 years) with significant aortic regurgitation and aortic root enlargement underwent aortic valve repair and associated root reconstruction. The same prospective selection criteria and systematic valve repair approaches were followed throughout the study. Root management consisted of either root remodeling or reimplantation with Dacron prostheses. Kaplan-Meier techniques were used to assess major end points of all-cause mortality, reoperation, and repair failure. Univariable log-rank testing was used to identify associations between risk factors and major events. RESULTS: Early mortality was 2% (4 patients), and early repair failure was 3% (6 patients). New York Heart Association functional class was found to be a risk factor for early mortality and morbidity (odds ratio, 3.3; P = .03), whereas crossclamp time and cardiopulmonary time were risk factors for early mortality (odds ratio, 1.04; 95% confidence interval, 1-1.07; P = .01 and odds ratio, 1.02; 95% confidence interval, 1-1.03; P = .02), respectively. Survival at a mean follow-up of 48.6 ± 34.3 months (median follow-up, 43.6 months; range, 17.8-78 months) was 94%, with a freedom from reoperation of 91%. Univariable risk factors for mortality were preoperative New York Heart Association functional class and requirement for root replacement. Repair failure and reoperation were associated with bicuspid valve anatomy, subcommissural annuloplasty, and complex leaflet repair. Freedom from repair failure was associated with aortic reimplantation. CONCLUSIONS: Data from a prospective cohort of patients undergoing aortic valve repair and root reconstruction reinforce the satisfactory medium-term results obtained with valve reconstruction. Further analysis of these patient outcomes is necessary to draw definitive conclusions on operative techniques.
OBJECTIVES: Advantages of aortic valve repair and root reconstruction include maintenance of natural valve hemodynamic parameters and avoidance of prosthetic valve-related complications. However, general acceptance of valve reconstruction may be limited by paucity of long-term follow-up data from only a few centers. This report is intended to supplement existing outcome information for aortic valve repair. METHODS: Between 2003 and 2013, 200 consecutive patients (149 men, 51 women; mean age, 52.1 years) with significant aortic regurgitation and aortic root enlargement underwent aortic valve repair and associated root reconstruction. The same prospective selection criteria and systematic valve repair approaches were followed throughout the study. Root management consisted of either root remodeling or reimplantation with Dacron prostheses. Kaplan-Meier techniques were used to assess major end points of all-cause mortality, reoperation, and repair failure. Univariable log-rank testing was used to identify associations between risk factors and major events. RESULTS: Early mortality was 2% (4 patients), and early repair failure was 3% (6 patients). New York Heart Association functional class was found to be a risk factor for early mortality and morbidity (odds ratio, 3.3; P = .03), whereas crossclamp time and cardiopulmonary time were risk factors for early mortality (odds ratio, 1.04; 95% confidence interval, 1-1.07; P = .01 and odds ratio, 1.02; 95% confidence interval, 1-1.03; P = .02), respectively. Survival at a mean follow-up of 48.6 ± 34.3 months (median follow-up, 43.6 months; range, 17.8-78 months) was 94%, with a freedom from reoperation of 91%. Univariable risk factors for mortality were preoperative New York Heart Association functional class and requirement for root replacement. Repair failure and reoperation were associated with bicuspid valve anatomy, subcommissural annuloplasty, and complex leaflet repair. Freedom from repair failure was associated with aortic reimplantation. CONCLUSIONS: Data from a prospective cohort of patients undergoing aortic valve repair and root reconstruction reinforce the satisfactory medium-term results obtained with valve reconstruction. Further analysis of these patient outcomes is necessary to draw definitive conclusions on operative techniques.
Authors: Radosław Gocoł; Marek Jasiński; Damian Hudziak; Jarosław Bis; Aleksandra Żak; Piotr Duraj; Magdalena Mizia; J Scott Rankin; Marek A Deja Journal: Cardiol J Date: 2019 Impact factor: 2.737
Authors: Kenan W D Stern; Matthew T White; George R Verghese; Pedro J Del Nido; Tal Geva Journal: Ann Thorac Surg Date: 2015-06-30 Impact factor: 4.330
Authors: Marek J Jasinski; Kinga Kosiorowska; Radoslaw Gocol; Jakub Jasinski; Rafal Nowicki; Grzegorz Bielicki; Mikolaj Berezowski; Roman Przybylski; Marta Obremska; Marceli Lukaszewski; Anna Larysz; Andrzej Kansy; Marek A Deja Journal: Eur J Cardiothorac Surg Date: 2021-11-02 Impact factor: 4.191