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Management of aortic insufficiency in chronic aortic dissection
P M Pêgo-Fernandes1, N A Stolf, L F Moreira
1Heart Institute, University of São Paulo Medical School, Brazil.
Insights
Preserving the aortic valve during surgery for chronic aortic dissection and insufficiency yielded favorable outcomes, with most survivors in good functional class. Valve preservation showed comparable survival rates to valve replacement.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Valve Surgery
Background:
- Chronic aortic dissection and insufficiency pose significant surgical challenges.
- Aortic valve management is critical in these complex cases.
- Outcomes of valve preservation versus replacement require detailed analysis.
Purpose of the Study:
- To compare the outcomes of aortic valve preservation versus valve replacement in patients with chronic aortic dissection and insufficiency.
- To evaluate the efficacy and safety of aortic valve plastic procedures in select patients.
Main Methods:
- Retrospective analysis of 44 patients undergoing operation for chronic aortic dissection and insufficiency from 1980-1988.
- Comparison of patient groups based on aortic valve management: preservation (plastic procedure) versus replacement.
- Assessment of hospital mortality, late mortality, functional status, and reoperation rates.
Main Results:
- Aortic valve was preserved in 48% of patients.
- Hospital mortality was 11% (low-output syndrome, bleeding, neurological complications).
- Late mortality was 5%; 78% of survivors were in functional class I at follow-up (mean 18 months).
- Valve preservation showed higher, though not statistically significant, survival rates compared to valve replacement.
- Reoperations were required for prosthetic valve dysfunction and one case of redissection after valve repair.
Conclusions:
- Aortic valve preservation is a viable option in select patients with chronic aortic dissection and insufficiency, offering good functional outcomes.
- While not statistically significant, valve preservation demonstrated a trend towards improved survival.
- Careful patient selection and surgical technique are crucial for successful valve preservation and minimizing complications.
Abstract:
From January 1980 to December 1988, 44 patients with chronic aortic dissection and aortic insufficiency underwent operation. This group of patients was analyzed to evaluate the outcome of those in whom the aortic valve was preserved compared with those having valve replacement. The overall preoperative characteristics of the two groups were similar except for the incidence of Marfan's syndrome. Valve replacement was the elected procedure in patients with valve degeneration or annuloaortic ectasia. In patients with leaflet prolapse with or without an enlarged annulus, a plastic procedure was used. In 48% of the patients, it was possible to preserve the valve. There were five hospital deaths (11%): three were due to low-output syndrome, one was due to bleeding, and one was due to neurological complications. There were two late deaths (5%). Follow-up of the 37 surviving patients ranged from 2 to 108 months (mean follow-up, 18 months). Seventy-eight percent of the survivors were in functional class I and the others were in class II. Two patients in whom the aortic valve was preserved had mild aortic insufficiency. Three patients with bioprostheses underwent reoperation because of prosthetic valve dysfunction. One patient who had aortoplasty and an aortic valve plastic procedure was seen with redissection and aortic insufficiency after 60 months and was reoperated on using the Bentall technique. The actuarial survival curves showed that patients who underwent valvoplasty had higher, but not significantly higher, survival rates than the valve replacement patients.(ABSTRACT TRUNCATED AT 250 WORDS)