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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
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Risk Factors for Late Aortic Valve Dysfunction After the David V Valve-Sparing Root Replacement
Jiro Esaki1, Bradley G Leshnower2, Jose N Binongo3
1Department of Cardiovascular Surgery, Otsu Red Cross Hospital, Otsu, Japan.
The Annals of Thoracic Surgery
|July 4, 2017
Summary
Valve-sparing root replacement (VSRR) offers good long-term survival. However, aortic root size ≥55 mm, bicuspid valves, and cusp repair increase risks for late aortic valve dysfunction after VSRR.
Area of Science:
- Cardiovascular Surgery
- Aortic Surgery
- Heart Valve Repair
Background:
- Valve-sparing root replacement (VSRR) is a key treatment for aortic root pathology.
- Late aortic valve dysfunction after VSRR necessitates reoperation, posing a significant concern.
Purpose of the Study:
- This study identifies risk factors for late aortic insufficiency (AI) and aortic stenosis (AS) following David V VSRR.
Main Methods:
- Retrospective review of 282 patients undergoing VSRR from 2005-2015.
- Cox proportional hazards regression analysis to determine risk factors for late AI and AS.
Main Results:
- Aortic root size ≥55 mm is a risk factor for late AI (HR 3.44, p=0.01).
- Bicuspid valve (HR 16.07, p=0.001) and cusp repair (HR 5.91, p=0.03) are risk factors for late AS.
- Seven-year cumulative incidence of reoperation, AI, and AS were 3.1%, 2.2%, and 0.8% respectively.
Conclusions:
- VSRR demonstrates low operative risk and favorable long-term survival, even in complex cases.
- Durable valve function is achievable, but specific factors predict late dysfunction.
- Aortic root size ≥55 mm, bicuspid valves, and cusp repair are independent risk factors for late aortic valve dysfunction post-VSRR.
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