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You are here: Contents > 2014 > Volume 23 Number 4 July 2014 > AORTIC VALVE DISEASE > Long-Term Outcomes after Aortic Valve Repair and Associated Aortic Root Reconstruction

Long-Term Outcomes after Aortic Valve Repair and Associated Aortic Root Reconstruction

Marek J. Jasinski1, Radoslaw Gocol1, J. Scott Rankin2, Marcin Malinowski1, Damian Hudziak1, Marek A. Deja1

1Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland, 2Department of Cardiac Surgery, Vanderbilt University, Nashville, TN, USA

Background and aim of the study: The advantages of aortic valve repair and root reconstruction include the maintenance of natural valve hemodynamics and an avoidance of prosthetic valve-related complications. However, the general acceptance of valve reconstruction currently may be limited by a paucity of long-term follow up data from only a few centers. The study aim was to supplement existing outcome information for aortic valve repair.

Methods: Between 2003 and 2012, a total of 150 consecutive patients (119 males, 31 females; mean age 51.1 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 identified any associations between risk factors and major events.

Results: The early mortality rate was 2.7% (n = 4), and early repair failure rate 3.3% (n = 5). At a mean follow up of 43.6 months (1st, 3rd percentile, 17.8, 78.0 months), the survival rate was 93% and freedom from reoperation 91%. Univariable risk factors for mortality included advanced preoperative NYHA class and a requirement for root replacement. Repair failure and reoperation were associated with bicuspid valve anatomy, subcommissural annuloplasty, leaflet resection with pericardial patching, and Gore-Tex leaflet reinforcement.

Conclusion: The present data, acquired from a prospective cohort of patients undergoing aortic valve repair and root reconstruction, reinforced the satisfactory late results obtained with valve reconstruction. These findings also support a broader application of aortic valve repair in future patients.

The Journal of Heart Valve Disease 2014;23:414-423
Long-Term Outcomes after Aortic Valve Repair and Associated Aortic Root Reconstruction

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