Article ; Online: Impact of Cusp Repair on Reoperation Risk After the David Procedure.
The Annals of thoracic surgery
2016 Volume 102, Issue 5, Page(s) 1503–1511
Abstract: ... 157 consecutive patients underwent valve-sparing aortic root replacement with the David technique ...
| Abstract | Background: We assessed whether additional cusp repair during valve-sparing aortic root replacement affects the echocardiographic mid-term results; a subgroup analysis among patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) was performed. Methods: Between June 2002 and May 2015, 157 consecutive patients underwent valve-sparing aortic root replacement with the David technique. Thirty patients (19%) had BAV. In 19 patients (12%), cusp motion or anatomic abnormalities contributed in determining aortic regurgitation requiring an additional cusp repair. Mean follow-up was 7 ± 3.4 years. Results: The cumulative 1-, 5-, and 12-year survival rates were 98%, 94%, and 90%, respectively. Fourteen patients (9%) required aortic valve replacement during follow-up. In 2 patients the underlying cause was bacterial endocarditis. Freedom from aortic valve reoperation was 96% at 1 year, 92% at 5 years, and 89% at 12 years. Reoperation rate was significantly higher (p < 0.001) in patients who received leaflet repair compared with patients who did not, with a freedom from reoperation at 8 years of 58% versus 94%. Among patients with BAV, those who did not require cusp repair had a freedom from reoperation at 8 years of 94%, with a significant difference compared with patients who received cusp repair (p = 0.04). Cusp repair did not affect reoperation risk in patients with tricuspid aortic valve. Conclusions: Adjunctive cusp repair seems to affect the mid-term reoperation risk in patients with BAV and not in patients with tricuspid aortic valve. We recommend caution in using this technique in case of asymmetric BAV requiring cusp repair. |
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| MeSH term(s) | Adult ; Aorta/surgery ; Aortic Aneurysm/surgery ; Aortic Valve/abnormalities ; Aortic Valve/surgery ; Aortic Valve Insufficiency/surgery ; Bicuspid Aortic Valve Disease ; Blood Vessel Prosthesis Implantation/methods ; Calcinosis/epidemiology ; Calcinosis/etiology ; Calcinosis/surgery ; Endocarditis, Bacterial/etiology ; Endocarditis, Bacterial/surgery ; Female ; Follow-Up Studies ; Heart Valve Diseases/epidemiology ; Heart Valve Diseases/etiology ; Heart Valve Diseases/surgery ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Organ Sparing Treatments ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery ; Reoperation/statistics & numerical data ; Retrospective Studies ; Risk |
| Language | English |
| Publishing date | 2016-07-14 |
| Publishing country | Netherlands |
| Document type | Journal Article ; Video-Audio Media |
| ZDB-ID | 211007-6 |
| ISSN | 1552-6259 ; 0003-4975 |
| ISSN (online) | 1552-6259 |
| ISSN | 0003-4975 |
| DOI | 10.1016/j.athoracsur.2016.04.061 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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