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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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Valve-sparing aortic root replacement: Long-term variables significantly associated with mortality and morbidity.
Varun J Sharma1, Abbie Kangarajah2, Amy Yang2
1Brian F. Buxton Department of Cardiac and Thoracic Aortic Surgery, Austin Health, Melbourne, Australia; Department of Surgery, Melbourne Medical School, University of Melbourne, Melbourne, Australia.
The Journal of Thoracic and Cardiovascular Surgery
|November 22, 2023
Summary
Valve-sparing aortic root replacement offers excellent long-term results, with low mortality and reintervention rates. Bicuspid valve disease and leaflet repair are linked to reintervention.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Surgery
Background:
- Valve-sparing aortic root replacement (VSARR) is an alternative to prosthetic valves in aortic root surgery.
- Durability and influencing factors of VSARR outcomes require further investigation.
Purpose of the Study:
- To review mid- to long-term outcomes of VSARR.
- To identify factors impacting survival, reintervention, and insufficiency after VSARR.
Main Methods:
- Retrospective review of 284 patients undergoing VSARR (1999-2022).
- Median follow-up of 6.43 years (up to 22 years).
- Kaplan-Meier, Cox proportional hazard, and Fine-Gray analyses for survival, reintervention, and insufficiency.
Main Results:
- 30-day mortality was 1.8%. 10-year freedom from mortality was 88.2%.
- 10-year freedom from aortic reintervention was 79.8%. Factors: leaflet repair (HR 8.13) and bicuspid valve (HR 2.23).
- 10-year freedom from aortic insufficiency was 80.7%. Reintervention in bicuspid valves often due to stenosis; in tricuspid valves, due to insufficiency.
Conclusions:
- VSARR demonstrates excellent long-term durability with low mortality and reintervention rates.
- Concomitant leaflet repair and bicuspid aortic valve disease are significant predictors of reintervention.
