Ahmad Zeeshan1, Jay J Idrees1, Douglas R Johnston1, Jeevanantham Rajeswaran2, Eric E Roselli1, Edward G Soltesz1, A Marc Gillinov1, Brian Griffin3, Richard Grimm3, Donald F Hammer3, Gösta B Pettersson1, Eugene H Blackstone4, Joseph F Sabik1, Lars G Svensson5. 1. Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. 2. Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio. 3. Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. 4. Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio. 5. Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: svenssl@ccf.org.
Abstract
BACKGROUND: To determine the value of aortic valve repair rather than replacement for valve dysfunction, we assessed late outcomes of various repair techniques in the contemporary era. METHODS: From January 2001 to January 2011, aortic valve repair was planned in 1,124 patients. Techniques involved commissural figure-of-8 suspension sutures (n = 63 [6.2%]), cusp repair with commissuroplasty (n = 481 [48%]), debridement (n = 174 [17%]), free-margin plication (n = 271 [27%]) or resection (n = 75) or both, or annulus repair with resuspension (n = 230 [23%]), root reimplantation (n = 252 [25%]), or remodeling (n = 35 [3.5%]). RESULTS: Planned repair was aborted for replacement in 115 patients (10%); risk factors included greater severity of aortic regurgitation (AR; p = 0.0002) and valve calcification (p < 0.0001). In-hospital outcomes for the remaining 1,009 patients included death (12 [1.2%]), stroke (13 [1.3%]), and reoperation for valve dysfunction (14 [1.4%]). Freedom from aortic valve reoperation at 1, 5, and 10 years was 97%, 93%, and 90%, respectively. Figure-of-8 suspension sutures, valve resuspension, and root repair and replacement were least likely to require reoperation; cusp repair with commissural sutures, plication, and commissuroplasty was most likely (p < 0.05). Survival at 1, 5, and 10 years was 96%, 92%, and 83%. Immediate postoperative AR grade was none-mild (94%), moderate (5%), and severe (1%). At 10 years after repair, AR grade was none (20%), mild (33%), moderate (26%), and severe (21%). Patients undergoing root procedures were less likely to have higher-grade postoperative AR (p < 0.0001). CONCLUSIONS: Valve repair is effective and durable for treating aortic valve dysfunction. Greater severity of AR preoperatively is associated with higher likelihood of repair failure. Commissural figure-of-8 suspension sutures and repair with annular support have the best long-term durability.
BACKGROUND: To determine the value of aortic valve repair rather than replacement for valve dysfunction, we assessed late outcomes of various repair techniques in the contemporary era. METHODS: From January 2001 to January 2011, aortic valve repair was planned in 1,124 patients. Techniques involved commissural figure-of-8 suspension sutures (n = 63 [6.2%]), cusp repair with commissuroplasty (n = 481 [48%]), debridement (n = 174 [17%]), free-margin plication (n = 271 [27%]) or resection (n = 75) or both, or annulus repair with resuspension (n = 230 [23%]), root reimplantation (n = 252 [25%]), or remodeling (n = 35 [3.5%]). RESULTS: Planned repair was aborted for replacement in 115 patients (10%); risk factors included greater severity of aortic regurgitation (AR; p = 0.0002) and valve calcification (p < 0.0001). In-hospital outcomes for the remaining 1,009 patients included death (12 [1.2%]), stroke (13 [1.3%]), and reoperation for valve dysfunction (14 [1.4%]). Freedom from aortic valve reoperation at 1, 5, and 10 years was 97%, 93%, and 90%, respectively. Figure-of-8 suspension sutures, valve resuspension, and root repair and replacement were least likely to require reoperation; cusp repair with commissural sutures, plication, and commissuroplasty was most likely (p < 0.05). Survival at 1, 5, and 10 years was 96%, 92%, and 83%. Immediate postoperative AR grade was none-mild (94%), moderate (5%), and severe (1%). At 10 years after repair, AR grade was none (20%), mild (33%), moderate (26%), and severe (21%). Patients undergoing root procedures were less likely to have higher-grade postoperative AR (p < 0.0001). CONCLUSIONS: Valve repair is effective and durable for treating aortic valve dysfunction. Greater severity of AR preoperatively is associated with higher likelihood of repair failure. Commissural figure-of-8 suspension sutures and repair with annular support have the best long-term durability.
Authors: Hector I Michelena; Alessandro Della Corte; Arturo Evangelista; Joseph J Maleszewski; William D Edwards; Mary J Roman; Richard B Devereux; Borja Fernández; Federico M Asch; Alex J Barker; Lilia M Sierra-Galan; Laurent De Kerchove; Susan M Fernandes; Paul W M Fedak; Evaldas Girdauskas; Victoria Delgado; Suhny Abbara; Emmanuel Lansac; Siddharth K Prakash; Malenka M Bissell; Bogdan A Popescu; Michael D Hope; Marta Sitges; Vinod H Thourani; Phillippe Pibarot; Krishnaswamy Chandrasekaran; Patrizio Lancellotti; Michael A Borger; John K Forrest; John Webb; Dianna M Milewicz; Raj Makkaar; Martin B Leon; Stephen P Sanders; Michael Markl; Victor A Ferrari; William C Roberts; Jae-Kwan Song; Philipp Blanke; Charles S White; Samuel Siu; Lars G Svensson; Alan C Braverman; Joseph Bavaria; Thoralf M Sundt; Gebrine El Khoury; Ruggero De Paulis; Maurice Enriquez-Sarano; Jeroen J Bax; Catherine M Otto; Hans-Joachim Schäfers Journal: Radiol Cardiothorac Imaging Date: 2021-07-22
Authors: Lars G Svensson; Brad F Rosinski; Nicholas J Tucker; A Marc Gillinov; Jeevanantham Rajeswaran; Eric E Roselli; Douglas R Johnston; Milind Y Desai; Brian P Griffin; Eugene H Blackstone Journal: Aorta (Stamford) Date: 2022-08-07