Correspondence to Professor Marek A Deja, Department of Cardiac Surgery, Medical University of Silesia, Katowice 40-035, Poland; mdeja@sum.edu.pl Composite aortic valve-root conduit replacement has ...been the mainstay and a ‘gold standard’ of aortic root aneurysm surgery for the last half century. The latter remains the most difficult to repair and yields the least favourable results.4 In the classic paper, Boodhwani et al found that the direction of regurgitant jet on preoperative transoesophageal echocardiography was 92% sensitive and 96% specific for aortic cusp prolapse.5 To complicate things further, surgeons have found that durability of aortic valve-sparing procedures depended on the position of cusps in diastole in aortic root. Interestingly, it has been shown that the results improve with increased number of cusp manipulations.7 Ehrlich et al from Saarland University Medical Centre report their analysis of aortic cusp abnormalities in patients with trileaflet aortic valve and root aneurysm.8 They describe intraoperative findings in 582 patients who underwent aortic root repair for aortic regurgitation or aneurysm. J Thorac Cardiovasc Surg 1992; 103: 617–22. doi:10.1016/S0022-5223(19)34942-6 http://www.ncbi.nlm.nih.gov/pubmed/1532219 3 Vahanian A, Beyersdorf F, Praz F. ESC/EACTS guidelines for the management of valvular heart disease developed by the task force for the management of valvular heart disease of the European Society of cardiology (ESC) and the European association for Cardio-Thoracic surgery (EACTS).
The optimal surgical strategy (repair vs replacement) for patients with secondary mitral (MV) regurgitation is questionable.
Patients who underwent MV repair or replacement for functional or ischemic ...mitral regurgitation between 2006 and 2017 were identified in Polish National Registry of Cardiac Surgery Procedures. Patients, who underwent additional procedures other than coronary artery bypass grafting or tricuspid valve surgery, as well as redo or emergency cases, were excluded. The long-term survival was verified based on National Health Fund registry. The survival was compared between MV repair and replacement both in the whole cohort and after propensity score matching. The Cox regression was used to seek for independent predictors of survival.
Of 7633 identified patients, 1793 (23%) underwent MV replacement and 5840 (77%) underwent MV repair. Coronary artery bypass surgery was performed together with MV repair in 3992 (69%) patients and together with MV replacement in 915 (52%) patients (P < .001). Tricuspid valve surgery was added to 1393 (24%) MV repairs and to 561 (32%) MV replacements (P < .001). The crude actuarial 5-year survival was 71% (95% confidence interval CI, 70%-72%) in the repair group and 66% (95% CI, 63%-68%) in the replacement group (P < .001). MV replacement was an independent predictor of mortality (hazard ratio, 1.32; 95% CI, 1.17-1.49) (P < .001) in Cox regression modeling. In the propensity-matched cohort (1105 pairs), the long-term mortality was also significantly higher in the replacement group (hazard ratio, 1.24; 95% CI, 1.06-1.45; P = .008).
Repair of secondary mitral regurgitation has an associated survival benefit compared with MV replacement.
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Abstract
OBJECTIVES
This study presents the results of 17 years of experience with bicuspid aortic valve (BAV) repair and the analysis of factors associated with repair failure and early ...echocardiographic outcome.
METHODS
Between 2003 and 2020, a total of 206 patients mean age: 44.5 ± 15.2 years; 152 males (74%) with BAV insufficiency with or without aortic dilatation underwent elective aortic valve repair performed by a single surgeon with a mean follow-up of 5 ± 3.5 years. The transthoracic echocardiography examinations were reported.
RESULTS
There were no deaths during the hospital stay, and all but 1 patient survived the follow-up period (99.5%). Overall, 10 patients (5%) developed severe insufficiency and 2 (1%) developed aortic dilatation requiring reoperation. Freedom from reoperation at 7 years reached 91.8%. Type 2 BAV configuration hazard ratio (HR) 3.9; 95% confidence interval (CI): 1.01–60; P = 0.049, no sinotubular junction remodelling (HR 7; 95% CI: 1.7–23; P = 0.005), no circumferential annuloplasty (HR 3.9; 95% CI: 1.01–64; P = 0.047) and leaflet resection (HR 5.7; 95% CI 1.2–13. P = 0.017) have been identified as a risk factor of redo operation. Parameters of the postoperative left ventricle reverse remodelling improved significantly early after the operation and later at 2 years evaluation.
CONCLUSIONS
The repair of BAV offers good short- and mid-term results providing a significant reverse left ventricular remodelling. Type 0 BAV preoperative configuration, circumferential annuloplasty and sinotubular junction remodelling are associated with better repair durability.
Abstract
OBJECTIVES
The aim of this study was to compare the outcomes of tricuspid aortic valve (TAV) and bicuspid aortic valve (BAV) repair.
METHODS
We assessed mortality, freedom from reoperation ...and the rate of aortic valve regurgitation recurrence. Mortality in both groups was compared with expected survival, and risk factors for reoperation were identified.
RESULTS
From January 2010 to April 2020, a total of 368 elective aortic valve repair procedures were performed, including 223 (60.6%) in patients with TAV. The perioperative mortality was 0.7% in the BAV group and 3.6% in the TAV group (P = 0.079). Estimated survival at 5 years in the BAV versus TAV group was 97 ± 3% vs 80 ± 6%, respectively (P < 0.001). Freedom from reoperation at 5 years in the TAV versus BAV group was 96 ± 3% vs 93 ± 4%, respectively (P = 0.28). Grade 2 or more aortic valve regurgitation was noted in 9.9% of BAV patients and 11% of TAV patients (P = 0.66). Reoperation was predicted by cusp perforation hazard ratio 15.86 (4.44–56.61); P < 0.001, the use of pericardial patch hazard ratio 8.58 (1.96–37.53); P = 0.004 and aortic valve annulus diameter >27.5 mm hazard ratio 3.07 (0.99–9.58); P = 0.053.
CONCLUSIONS
BAV repair is as durable as TAV repair. BAV is not a predictor of a higher rate of reoperations. BAV repair yields survival comparable to expected. Cusp perforation, aortic valve annulus diameter >27.5 mm and the use of pericardial patch adversely impact long-term outcome of aortic valve repair.
Whether mitral valve repair during coronary artery bypass grafting (CABG) improves survival in patients with ischemic mitral regurgitation (MR) remains unknown.
Patients with ejection fraction ≤35% ...and coronary artery disease amenable to CABG were randomized at 99 sites worldwide to medical therapy with or without CABG. The decision to treat the mitral valve during CABG was left to the surgeon. The primary end point was mortality. Of 1212 randomized patients, 435 (36%) had none/trace MR, 554 (46%) had mild MR, 181 (15%) had moderate MR, and 39 (3%) had severe MR. In the medical arm, 70 deaths (32%) occurred in patients with none/trace MR, 114 (44%) in those with mild MR, and 58 (50%) in those with moderate to severe MR. In patients with moderate to severe MR, there were 29 deaths (53%) among 55 patients randomized to CABG who did not receive mitral surgery (hazard ratio versus medical therapy, 1.20; 95% confidence interval, 0.77-1.87) and 21 deaths (43%) among 49 patients who received mitral surgery (hazard ratio versus medical therapy, 0.62; 95% confidence interval, 0.35-1.08). After adjustment for baseline prognostic variables, the hazard ratio for CABG with mitral surgery versus CABG alone was 0.41 (95% confidence interval, 0.22-0.77; P=0.006).
Although these observational data suggest that adding mitral valve repair to CABG in patients with left ventricular dysfunction and moderate to severe MR may improve survival compared with CABG alone or medical therapy alone, a prospective randomized trial is necessary to confirm the validity of these observations.
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00023595.
Predictors of early and medium-term outcome of 200 consecutive aortic valve and root repairs Jasinski, Marek J., MD, PhD; Gocol, Radoslaw, MD; Malinowski, Marcin, MD ...
Journal of thoracic and cardiovascular surgery/The Journal of thoracic and cardiovascular surgery/The journal of thoracic and cardiovascular surgery,
01/2015, Volume:
149, Issue:
1
Journal Article
Peer reviewed
Open access
Objectives Advantages of aortic valve repair and root reconstruction include maintenance of natural valve hemodynamic parameters and avoidance of prosthetic valve-related complications. However, ...general acceptance of valve reconstruction may be limited by paucity of long-term follow-up data from only a few centers. This report is intended to supplement existing outcome information for aortic valve repair. Methods Between 2003 and 2013, 200 consecutive patients (149 men, 51 women; mean age, 52.1 years) with significant aortic regurgitation and aortic root enlargement underwent aortic valve repair and associated root reconstruction. The same prospective selection criteria and systematic valve repair approaches were followed throughout the study. Root management consisted of either root remodeling or reimplantation with Dacron prostheses. Kaplan-Meier techniques were used to assess major end points of all-cause mortality, reoperation, and repair failure. Univariable log-rank testing was used to identify associations between risk factors and major events. Results Early mortality was 2% (4 patients), and early repair failure was 3% (6 patients). New York Heart Association functional class was found to be a risk factor for early mortality and morbidity (odds ratio, 3.3; P = .03), whereas crossclamp time and cardiopulmonary time were risk factors for early mortality (odds ratio, 1.04; 95% confidence interval, 1-1.07; P = .01 and odds ratio, 1.02; 95% confidence interval, 1-1.03; P = .02), respectively. Survival at a mean follow-up of 48.6 ± 34.3 months (median follow-up, 43.6 months; range, 17.8-78 months) was 94%, with a freedom from reoperation of 91%. Univariable risk factors for mortality were preoperative New York Heart Association functional class and requirement for root replacement. Repair failure and reoperation were associated with bicuspid valve anatomy, subcommissural annuloplasty, and complex leaflet repair. Freedom from repair failure was associated with aortic reimplantation. Conclusions Data from a prospective cohort of patients undergoing aortic valve repair and root reconstruction reinforce the satisfactory medium-term results obtained with valve reconstruction. Further analysis of these patient outcomes is necessary to draw definitive conclusions on operative techniques.
It is better to be readmitted than dead Deja, Marek A., MD, PhD
Journal of thoracic and cardiovascular surgery/The Journal of thoracic and cardiovascular surgery/The journal of thoracic and cardiovascular surgery,
08/2017, Volume:
154, Issue:
2
Journal Article
Patients with CAD and LV dysfunction were assigned to either medical therapy alone or medical therapy plus CABG. At 5 years, there was no significant difference between the two study groups in the ...rate of death from any cause.
It is estimated that 5.8 million patients in the United States
1
and 15 million in Europe
2
have heart failure. Coronary artery disease is the most common substrate for heart failure in industrialized nations.
3
However, the role of coronary-artery bypass grafting (CABG) in the treatment of patients with coronary artery disease and heart failure has not been clearly established.
In three landmark clinical trials in the 1970s, a total of 2234 patients with chronic stable angina were randomly assigned to undergo CABG or receive medical therapy alone.
4
–
6
The findings from these trials led to recommendations supporting the use of CABG . . .
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