Valve-sparing aortic root repair without down-sizing of the annulus

Autor: Michael Zacher, Anno Diegeler, Xiaochun Zhan, Husam Hijazi, Paul P. Urbanski
Rok vydání: 2011
Předmět:
Male
Time Factors
medicine.medical_treatment
Kaplan-Meier Estimate
Aortic valve replacement
Risk Factors
Germany
Odds Ratio
Cardiac skeleton
Hospital Mortality
Prospective Studies
Prospective cohort study
Middle Aged
Aortic Aneurysm
Treatment Outcome
Aortic Valve
Replantation
cardiovascular system
Cardiology
Female
Cardiology and Cardiovascular Medicine
Pulmonary and Respiratory Medicine
Reoperation
medicine.medical_specialty
Aortic Valve Insufficiency
Regurgitation (circulation)
Risk Assessment
Blood Vessel Prosthesis Implantation
Aneurysm
Internal medicine
medicine
Humans
Cardiac Surgical Procedures
Aged
Proportional Hazards Models
business.industry
Odds ratio
Sinus of Valsalva
medicine.disease
Surgery
Echocardiography
Doppler
Color
Aortic Dissection
Logistic Models
Concomitant
business
Tomography
X-Ray Computed
Organ Sparing Treatments
Echocardiography
Transesophageal
Zdroj: The Journal of thoracic and cardiovascular surgery. 143(2)
ISSN: 1097-685X
Popis: Objectives The study was conducted to evaluate the intermediate results after patient-tailored aortic root repair with replacement of isolated sinuses adjusted to the existing aortic annulus diameter rather than annulus downsizing. Methods Between 2000 and 2009, 236 patients with aortic root disease underwent patient-tailored restoration of the aortic root according to its anatomopathologic condition with repair of 1, 2, or all 3 sinuses in 73, 94, and 69 patients, respectively. Concomitant cusp repair was performed in 106 patients. Insufficiency grades of 0/1+, 2+, 3+, and 4+ were presented in 59, 74, 74, and 29 patients, respectively. All data were collected prospectively and intention-to-treat analysis was performed. Results Valve repair was successful in all but 6 patients. At the most recent clinical and echocardiographic follow-up of the remaining patients, which averaged 43 ± 24 months (range, 0.3-115 months), 216 patients showed no or slight aortic regurgitation (grade 0/1+) and 10 patients showed grade 2+. Another 4 patients had grade 3+ regurgitation and underwent aortic valve replacement. The actuarial freedom from aortic regurgitation grade 3+ or more at 8 years was 95.2%. Multivariate logistic regression analysis identified cusp repair as the independent risk factor for an aortic regurgitation grade of 2+ or more with an odds ratio of 10.9 (95% confidence interval, 2.5-47.7; P = .002). The association between aortic annulus size and functional results after repair could not be demonstrated. Conclusions Aortic root repair with replacement of isolated sinuses adjusted to the existing aortic annulus leads to excellent, durable results and can be recommended. Cusp disease is a leading aspect affecting functional results of repair. Therefore, establishment of reproducible cusp repair techniques is of utmost importance for further development of reconstructive aortic valve surgery.
Databáze: OpenAIRE
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