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Aortic Regurgitation III: Medical Management

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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...

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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement

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Published on: December 11, 2017

Long-term outcomes after aortic valve replacement using a 19-mm bioprosthesis.

Homare Okamura¹, Sho Kusadokoro¹, Makiko Mieno²

¹Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery

|August 25, 2021

Summary

Surgical aortic valve replacement (SAVR) with a 19-mm bioprosthesis shows good long-term survival and hemodynamic results in patients with aortic stenosis. Prosthesis-patient mismatch did not impact long-term outcomes.

Keywords:

19-mm bioprosthesis Aortic valve replacement Prosthesis-patient mismatch

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Area of Science:

Cardiovascular Surgery
Bioprosthetic Valves
Aortic Stenosis Management

Background:

Transcatheter aortic valve replacement (TAVR) improves hemodynamics in aortic stenosis with small annuli.
Limited long-term data exist for surgical aortic valve replacement (SAVR) in these patients.

Purpose of the Study:

To evaluate the long-term clinical and hemodynamic outcomes of SAVR using a 19-mm bioprosthesis.
To assess the impact of prosthesis-patient mismatch on outcomes.

Main Methods:

Retrospective analysis of consecutive patients undergoing SAVR with a 19-mm bioprosthesis (2008-2012).
Median follow-up of 7.7 years.
Assessment of survival, major adverse valve-related events (MAVEs), heart failure, and echocardiographic parameters.

Main Results:

132 patients included; 27.3% moderate and 5.3% severe prosthesis-patient mismatch.
5-year survival: 79.4%; 10-year survival: 52.9%.
5-year freedom from MAVEs: 89.6%; 10-year freedom from MAVEs: 74.2%.
No significant impact of prosthesis-patient mismatch on mortality or MAVEs.
Improved left ventricular ejection fraction and reduced gradients/mass observed on follow-up echocardiography.
Structural valve deterioration in 17 patients did not affect late survival or MAVE rates.

Conclusions:

SAVR with a 19-mm bioprosthesis offers satisfactory long-term clinical and hemodynamic outcomes.
Prosthesis-patient mismatch did not negatively influence long-term results.
The 19-mm bioprosthesis is a viable option for selected patients with small aortic annuli.