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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Replacement of the proximal aorta adds no further risk to aortic valve procedures
T Brett Reece1, R Ramesh Singh, Brendon M Stiles
1Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA.
Insights
Adding proximal aortic replacement to aortic valve surgery does not increase patient risk. This combined procedure may prevent future aortic complications and the need for additional surgeries.
Area of Science:
- Cardiovascular Surgery
- Aortic Surgery
- Valvular Heart Disease
Background:
- Aortic valve pathology frequently coexists with proximal aortic dilatation.
- Post-valve surgery, the proximal aorta can continue to enlarge, posing risks of rupture or dissection.
- Concurrent aortic valve and proximal aorta intervention may prevent future aortic procedures.
Purpose of the Study:
- To evaluate the safety and efficacy of combining proximal aortic replacement with aortic valve intervention.
- To determine if adding aortic replacement increases surgical risk compared to valve intervention alone.
Main Methods:
- Retrospective review of 430 aortic valve interventions and 146 combined aortic valve and proximal aortic replacements (1996-2004).
- Comparison of hospital mortality and complication rates between the two groups.
- Analysis using logistic regression to assess additional risks associated with aortic replacement.
Main Results:
- Hospital mortality and rates of bleeding/revision were similar between groups (3.8% vs 2.7% and 6.7% vs 9.5%, respectively).
- Pulmonary and renal complications were significantly higher in the valve-alone group (23.0% vs 11.6% and 8.2% vs 2.7%, respectively).
- Logistic regression confirmed no increased risk of death, neurologic, or cardiac events with combined aortic replacement.
Conclusions:
- Proximal aortic replacement during aortic valve surgery is safe and does not add significant risk.
- Combined procedures may be beneficial for patients with moderate proximal aortic enlargement.
- Consideration of aortic replacement during valve operations can prevent future aortic complications.
Background:
Aortic valve pathology is often associated with proximal aortic dilatation. Even after valve surgery, the proximal aorta can continue to dilate and thus be at risk for rupture, dissection, or later aortic replacement. We hypothesized that the addition of proximal aortic intervention adds no further risk to aortic valve surgery, which may avoid subsequent proximal aortic procedures or catastrophes.
Methods:
Between 1996 and 2004, 430 aortic valve interventions alone and 146 aortic valves with proximal aortic replacements were identified in elective adult patients. The age in the valve-alone patients (68.8 years) was slightly higher than the valve-plus-aorta group (valve/aorta, 60.5 years; p < 0.01), but comorbidities were similar between groups. We compared groups based on hospital mortality and incidence of complications.
Results:
The 30-day mortality was similar between groups (valve-alone, 3.8% versus valve/aorta, 2.7%; p = 0.5), as were rates for bleeding and operative revision (valve-alone, 6.7% versus valve/aorta, 9.5%; p = 0.5). Pulmonary (valve-alone, 23.0% versus valve/aorta, 11.6%) and renal complications (valve-alone, 8.2% versus valve/aorta, 2.7%) were higher in the valve-alone group (p = 0.02). Logistic regression demonstrated no additional risk of death, neurologic, or cardiac event with replacement of the proximal aorta.
Conclusions:
Proximal aortic replacement adds no risk to the patient beyond the aortic valve intervention alone. These findings suggest proximal aortic replacement is safe for patients undergoing valve operations. Patients with a moderately enlarged proximal aorta that may dilate further should also be considered for aortic replacement at the time of valve procedures.
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