Reoperation for non-structural valvular dysfunction caused by pannus ingrowth in aortic valve prosthesis

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery
• Prosthetic Valve Dysfunction

Background:

• Pannus ingrowth is a cause of late non-structural dysfunction in prosthetic aortic valves.
• This dysfunction can occur years after initial heart valve surgery.

Purpose of the Study:

• To present clinical experience with prosthetic aortic valve dysfunction due to pannus ingrowth.
• To evaluate outcomes of reoperation for pannus overgrowth.

Main Methods:

• Retrospective review of 33 patients undergoing reoperation for prosthetic aortic valve dysfunction caused by pannus ingrowth (1999-2012).
• Analysis of pre- and post-reoperation hemodynamic data, including mean pressure gradient and effective orifice area index (EOAI).
• Concomitant procedures, such as mitral valve replacement (MVR), were noted.

Main Results:

• The mean interval from previous surgery was 16.7 years; rheumatic valve disease was the most common etiology.
• Pre-reoperation mean EOAI was 0.97 cm²/m² and mean pressure gradient was 39.1 mmHg.
• Post-reoperation, mean EOAI significantly increased to 1.16 cm²/m² (p < 0.001) and mean pressure gradient decreased to 11.9 mmHg (p < 0.001).
• In-hospital mortality was 6.1%, with late death in 18.2% of patients.

Conclusions:

• Pannus ingrowth causing non-structural dysfunction is associated with small EOAI and combined MVR for rheumatic disease.
• Reoperation for pannus removal and aortic valve replacement (AVR) in symptomatic patients yields good clinical outcomes.
• Aggressive pannus resection and AVR are recommended to prevent complications.