Bicuspid valve repair outcomes are improved with reduction and stabilization of sinotubular junction and annulus with external annuloplasty
Language English Country United States Media print-electronic
Document type Journal Article
PubMed
36535821
DOI
10.1016/j.jtcvs.2022.11.021
PII: S0022-5223(22)01262-4
Knihovny.cz E-resources
- Keywords
- annuloplasty, aortic aneurysm, aortic insufficiency, aortic valve repair, bicuspid aortic valve,
- MeSH
- Cardiac Valve Annuloplasty * adverse effects mortality methods MeSH
- Aortic Aneurysm surgery diagnostic imaging mortality MeSH
- Aortic Valve surgery abnormalities diagnostic imaging physiopathology MeSH
- Aortic Valve Insufficiency * surgery physiopathology diagnostic imaging mortality MeSH
- Bicuspid Aortic Valve Disease * surgery physiopathology MeSH
- Time Factors MeSH
- Heart Valve Prosthesis Implantation adverse effects instrumentation MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Postoperative Complications etiology MeSH
- Reoperation statistics & numerical data MeSH
- Retrospective Studies MeSH
- Risk Factors MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
OBJECTIVE: We investigated long-term outcomes of bicuspid aortic valve (BAV) repair, with external annuloplasty, according to aorta phenotype. METHODS: Between 2003 and 2020, all patients with BAV operated on for aortic insufficiency (AI) and/or aneurysm were included. Repairs included isolated AI repair with subvalvular with or without sinotubular junction (STJ) (single or double) annuloplasty, supracoronary aorta replacement (with or without hemiroot remodeling), and root remodeling with external subvalvular ring annuloplasty. RESULTS: Among 343 patients operated, reparability rate was 81.3% (n = 279; age 46 ± 13.3 years). At 10 years (median follow-up: 3.42 years; interquartile range, 1.1, 5.8), survival was 93.9% (n = 8 deaths, similar to general population), cumulative incidence of reoperation was 6.2% (n = 10), AI grade >2 was 5.8% (n = 9), and grade >1 was 23.0% (n = 30). BAV repair stabilizing both the annulus and STJ with annuloplasty, compared with nonstabilized STJ repair (single annuloplasty), had lower incidence of reoperation (2.6% vs 22.5%, P = .0018) and AI grade >2 (1.2% vs 23.6%, P < .001) at 9 years. Initial commissural angle <160° was not a risk factor for reoperation, compared with angle ≥160° if symmetrical repair was achieved (2.7% and 4.1%, respectively, at 6 years, P = .85). Multivariable model showed that absence of STJ stabilization (odds ratio, 6.7; 95% confidence interval, 2.1-20, P = .001) increased recurrent AI, but not initial commissural angle <160° (odds ratio, 1.01; 95% confidence interval, 0.39-2.63, P = .98). Commissures adjusted symmetrically led to lower transvalvular gradient, compared with nonsymmetrical repair (8.7 mm Hg vs 10.2 mm Hg, P = .029). CONCLUSIONS: BAV repair, tailored to aorta phenotype, is associated with excellent durable outcomes if both annulus and STJ are reduced and stabilized with external ring annuloplasty. Commissural angle <160° is not associated with reoperation if symmetrical repair is achieved.
Department of Cardiac Surgery Charles University Faculty of Medicine Hradec Kralove Czech Republic
Department of Cardiac Surgery Royal Brompton and Harefield Hospital London United Kingdom
Department of Cardiovascular and Thoracic Surgery Pitié Salpêtrière APHP Hospital Paris France
Department of Pediatric Cardiac Surgery Necker APHP Hospital Paris France
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