Abstract
OBJECTIVES
The goal of this study was to analyse early- and long-term outcomes of aortic valve reimplantation (David operation) in patients with heritable thoracic aortic disease.
METHODS
...This is a retrospective observational analysis using data from a prospectively maintained surgical database from March 2004 to April 2021. Patients with heritable thoracic aortic disease were included in the study.
RESULTS
A total of 157 patients with aortic root aneurysm with the diagnosis of heritable thoracic aortic disease received the David procedure. Marfan syndrome was found in 143 (91.1%) patients, Loeys-Dietz in 13 and Ehler-Danlos in 1 patient. The median age was 35.0 (IQR: 17.5) years and the median ascending aorta diameter in the Valsalva sinuses was 48 mm (IQR: 4). A Valsalva graft was used in 8 patients; the David V technique was performed in the rest of the cases. The median follow-up time was 7.3 years standard deviation: 0.58, 95% confidence interval (CI): 6.12–8.05. Only 2 patients died during the follow-up period. The overall survival was 99% (95% CI: 95%; 99%); 98% (95% CI: 92%; 99%); and 98% (95% CI: 92%; 99%) at 5, 10 and 15 years. Freedom from significant aortic regurgitation (AR> II), reintervention and postoperative type-B dissection was 90% (95% CI: 77%; 95%), 96% (95% CI: 91%; 99%) and 87% (95% CI: 68%; 95%) at 15 years, respectively. No differences were found in any outcome between Marfan syndrome and Loeys-Dietz syndrome. No statistically significant differences in survival were found when we compared expected gender- and age-specific population survival values.
CONCLUSIONS
The David operation is an excellent option for the treatment of patients with heritable thoracic aortic disease and dilatated aortic root. Surgical expertise in referral centres is essential to achieve the best long-term results.
Connective tissue syndromes are genetic disorders that frequently involve musculoskeletal, cardiovascular and ocular manifestations.
4-dimensional–flow cardiac magnetic resonance in patients with aortic dissection in chronic/post repair phase as a complementary diagnostic tool for anatomic-functional evaluation. Quali-quantitative ...analysis of 3 patients with this pathology clearly showing the true/false lumen, quantitative flow in false lumen, and helping in discerning lumen origin from different arterial vessels. (
Level of Difficulty: Advanced.
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Desde hace más de 3 años, la Sociedad Española de Cirugía Cardiovascular y Endovascular inició el Registro Español de Cirugía Cardiaca (RECC) con el fin de ofrecer a todos los servicios de cirugía ...cardiaca a nivel nacional un registro a nivel de paciente. El objetivo de este estudio es ofrecer una visión global de los datos introducidos en el RECC en el periodo comprendido entre el 8 de febrero del 2021 y el 8 de febrero del 2024 de los centros participantes que han aportado datos, de al menos 40 intervenciones. La información ha sido analizada de forma anónima a nivel de paciente, hospital y provincia. Para la estimación de la mortalidad ajustada por riesgo se utilizó la escala de estimación de riesgo preoperatorio EuroSCORE II. Se han incluido en el RECC un total de 10.852 intervenciones, de las cuales 9236 se trataban de cirugías cardiacas mayores. Del total de intervenciones mayores, el 53,4% (n=4935) de los procedimientos mayores fueron cirugías valvulares, el 25,2% (n=2324) cirugías de revascularización miocárdica, el 15,0% (n=1387) procedimientos sobre la aorta. La media del EuroSCORE II de las cirugías cardiacas mayores fue del 5,5% (DE 8,6), la mortalidad global de la serie fue del 5,1% y el IMAR de los procedimientos mayores fue del 0,92. En el 2023, la media del EuroSCORE II fue del 5,4%, la mortalidad observada fue del 6,4% y el IMAR del 1,18. En el 2023, el EuroSCORE II infraestimó en los pacientes de bajo riesgo.
More than three years ago, the Spanish Society of Cardiovascular and Endovascular Surgery started the Spanish Registry of Cardiac Surgery (RECC) in order to offer all cardiac surgery services nationwide a patient-level registry. The objective of this study is to offer a global vision of the data entered into the RECC in the period between february 8, 2021 and february 8, 2024 of the participating centers that have contributed data from at least 40 interventions. The information has been analyzed anonymously at the patient, hospital and province level. To estimate risk-adjusted mortality, the EuroSCORE II preoperative risk estimation scale was used. A total of 10,852 interventions have been included in the RECC, of which 9,236 were major cardiac surgeries. 53.4% (n=4,935) of major procedures were valve surgeries, 25.2% (n=2,324) myocardial revascularization surgeries and 15.0% (n=1,387) aorta procedures. The mean EuroSCORE II of major cardiac surgeries was 5.5% (SD 8.6), the overall mortality was 5.1% and the RAMR of major procedures was 0.92. In 2023, the mean EuroSCORE II was 5.4%, the observed mortality was 6.4% and the RAMR was 1.18. In 2023, the EuroSCORE II underestimated low-risk patients.
