Impact of Cusp Repair on Reoperation Risk After the David Procedure.
Fabrizio Settepani1, Antioco Cappai1, Alessio Basciu1
1Department of Cardiac Surgery, Humanitas Clinical and Research Center, Rozzano, Milan, Italy.
The Annals of Thoracic Surgery
|July 17, 2016
Summary
Adjunctive cusp repair during valve-sparing aortic root replacement may increase reoperation risk in patients with bicuspid aortic valves (BAV). This technique did not impact outcomes in tricuspid aortic valve (TAV) patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Valve Repair
- Aortic Root Replacement
Background:
- Valve-sparing aortic root replacement (VSARR) is a complex procedure.
- Assessing outcomes of adjunctive cusp repair in VSARR is crucial.
- Subgroup analysis in bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients was performed.
Purpose of the Study:
- To evaluate the mid-term echocardiographic results of VSARR.
- To determine the impact of additional cusp repair on VSARR outcomes.
- To compare outcomes between BAV and TAV patients undergoing VSARR with cusp repair.
Main Methods:
- 157 patients underwent VSARR using the David technique (June 2002-May 2015).
- 30 patients had BAV; 19 required additional cusp repair due to leaflet abnormalities.
- Mean follow-up was 7 years; survival and reoperation rates were analyzed.
Main Results:
- Overall survival was high (98% at 1 year, 90% at 12 years).
- Reoperation rates were significantly higher in patients receiving cusp repair (58% at 8 years vs. 94%).
- In BAV patients, cusp repair was associated with a higher reoperation risk (p=0.04), unlike in TAV patients.
Conclusions:
- Adjunctive cusp repair in VSARR appears to increase mid-term reoperation risk in BAV patients.
- Cusp repair did not significantly affect reoperation risk in TAV patients.
- Caution is advised when performing cusp repair in BAV patients with asymmetric anatomy.
