Remodeling root repair with an external aortic ring annuloplasty
Language English Country United States Media print-electronic
Document type Journal Article, Multicenter Study, Observational Study, Video-Audio Media
PubMed
28187973
DOI
10.1016/j.jtcvs.2016.12.031
PII: S0022-5223(17)30015-6
Knihovny.cz E-resources
- Keywords
- aortic annuloplasty, aortic ring, effective height, remodeling, valve repair, valve sparing,
- MeSH
- Cardiac Valve Annuloplasty adverse effects instrumentation mortality MeSH
- Aorta diagnostic imaging physiopathology surgery MeSH
- Aortic Aneurysm diagnostic imaging mortality physiopathology surgery MeSH
- Aortic Valve abnormalities diagnostic imaging physiopathology surgery MeSH
- Aortic Valve Insufficiency diagnostic imaging mortality physiopathology surgery MeSH
- Echocardiography, Doppler, Color MeSH
- Bicuspid Aortic Valve Disease MeSH
- Time Factors MeSH
- Blood Vessel Prosthesis * MeSH
- Blood Vessel Prosthesis Implantation adverse effects instrumentation mortality MeSH
- Heart Valve Prosthesis Implantation adverse effects instrumentation mortality MeSH
- Progression-Free Survival MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Heart Valve Diseases diagnostic imaging mortality physiopathology surgery MeSH
- Recovery of Function MeSH
- Polyethylene Terephthalates MeSH
- Postoperative Complications etiology MeSH
- Prosthesis Design MeSH
- Registries MeSH
- Risk Factors MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Heart Valve Prosthesis * MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Video-Audio Media MeSH
- Journal Article MeSH
- Multicenter Study MeSH
- Observational Study MeSH
- Geographicals
- France MeSH
- Names of Substances
- Polyethylene Terephthalates MeSH
OBJECTIVE: Although the remodeling technique provides the most dynamic valve-sparing root replacement, a dilated annulus (>25 mm) is a risk factor for failure. Aortic annuloplasty aims to reduce the annulus diameter, thus increasing coaptation height to protect the repair. The results of 177 patients with remodeling and external aortic ring annuloplasty were studied. METHODS: Data were collected from the Aortic Valve repair InternATiOnal Registry. Preoperative aortic insufficiency grade 3 or greater was present in 79 patients (44.7%). The valve was bicuspid in 59 patients (33.3%). External annuloplasty was performed through a homemade Dacron ring (56) or a dedicated expansible aortic ring (121). RESULTS: Thirty-day mortality was 2.9% (5). Mean follow-up was 41.1 ± 36.4 months. For the whole series, freedom from valve-related reoperation, aortic insufficiency grade 3 or greater, aortic insufficiency grade 2 or greater, and major adverse valve-related events were 89.5%, 90.5%, 77.4%, and 86.6% at 7 years, respectively, with similar results for tricuspid and bicuspid valves. Since 2007, systematic use of calibrated expansible ring annuloplasty, followed 1 year later by systematic cusp effective height assessment, significantly increased 7-year freedom from valve-related reoperation, aortic insufficiency grade 3 or greater, and major adverse valve-related events up to 99.1% ± 0.9% (P = .017), 100% (P = .026), and 96.3% ± 1.8% (P = .035), respectively, whereas freedom from aortic insufficiency grade 2 or greater remained unaffected (78.1% ± 7.6%). Calibrated annuloplasty and effective height assessment were identified as protective factors from reoperation: hazard ratio, 0.13; 95% confidence interval, 0.02-1.06; P = .057 and hazard ratio, 0.11; 95% confidence interval, 0.01-0.95; P = .044, respectively. CONCLUSIONS: The standardization of remodeling root repair with calibrated expansible aortic ring annuloplasty and cusp effective height assessment improves valve repair outcomes.
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