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Full-root Aortic Valve Replacement by Stentless Aortic Xenografts in Patients with Small Aortic Roots
Published on: May 21, 2017
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Repeat aortic valve replacement for failing aortic root homograft
Ahmed F Sedeek1, Kevin L Greason1, Vuyisile T Nkomo2
1Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
The Journal of Thoracic and Cardiovascular Surgery
|January 23, 2019
Summary
Transcatheter aortic valve replacement and surgical aortic valve replacement for failing aortic root homografts carry significant risks. Vascular injury is more common with transcatheter aortic valve replacement, while bleeding is more frequent with surgical aortic valve replacement.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Devices
Background:
- Failing aortic root homografts necessitate repeat aortic valve replacement.
- Limited comparative data exist for transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) in this context.
Purpose of the Study:
- To compare the outcomes of TAVR and SAVR in patients undergoing repeat aortic valve replacement for failing aortic root homografts.
Main Methods:
- Retrospective review of 51 patients with failing aortic root homografts who underwent repeat aortic valve replacement.
- 11 patients received TAVR, and 40 patients received SAVR (including 30 composite valve/root replacements).
Main Results:
- Procedure-related complications occurred in 73% of patients.
- Vascular injury was higher in the TAVR group (36% vs 5%), while major bleeding was more common in the SAVR group (58% vs 0%).
- Procedure-related mortality was similar (9% for TAVR, 8% for SAVR), with no subsequent operations needed after TAVR compared to 5 after SAVR.
Conclusions:
- Repeat aortic valve replacement for failing aortic root homografts involves substantial morbidity and mortality, irrespective of the technique used.
- Minimizing vascular injury during TAVR may improve outcomes in this patient population.
Keywords:
homograft failurehomograft senescencesurgical aortic valve replacementtranscatheter valve insertiontranscatheter valve replacementvalve in valveMore Related Videos
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