Document Detail


Failing stentless aortic valves: redo aortic root replacement or valve in a valve?
MedLine Citation:
PMID:  22933569     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: Reoperation for failing stentless aortic valve replacement is a technically demanding procedure that has traditionally been tackled in one of two ways: either root replacement or the more conservative option of implanting a stented valve within the valve. We sought to determine the relative operative risks, follow-up status and medium to long-term survival of these two methods. METHODS: We conducted a retrospective review of a single surgeon's experience of the two techniques over a 10-year period from 2000 to 2010. Excluding cases of active endocarditis, 110 patients were identified, of which 65 underwent 'valve-in-valve' procedures ('Group A') and 45 had redo root replacement ('Group B'). The most common bioprostheses reoperated were homografts (roots or subcoronary implants) and Toronto Stentless Porcine Valves. Aortic valve replacement alone was performed in 68% in Group A and 64% in Group B, with males comprising 75% of Group A and 82% of Group B. Average ages were 61.5 ± 14.2 years and 61.9 ± 12.1 years, respectively. RESULTS: Operative and cardiopulmonary bypass durations were significantly greater for redo root procedures and correspondingly, postoperative complications were more common. Thirty-day mortality after valve-in-valve replacement was 3%, and after redo root replacement it was 11%. Despite significantly higher transvalvular gradients in Group B, the symptomatic status was equally good at 2 months, 1 year and last follow-up. At an average interval of 5.1 ± 2.7 years for Group A, survival was 83% vs 76% at 7.3 ± 2.9 years for Group B. There have been two reinterventions in Group A and 3 in Group B. Only one valve-in-valve patient has developed a paraprosthetic leak. CONCLUSIONS: This retrospective review has confirmed our hypothesis that where both root diameter permits and satisfactory debridement can be performed, valve-in-valve replacement is the more conservative surgical strategy for stentless aortic valve replacement revision. Although transvalvular gradients on echocardiography are significantly higher with the introduction of a stented prosthesis, medium-term outcomes in terms of symptomatic status, late complications and reintervention rate were non-inferior. We await the medium-term results of transcatheter aortic valve implantation for the same indication with interest.
Authors:
Jonathan Finch; Isabelle Roussin; John Pepper
Related Documents :
23517109 - High single-session success rate of endoscopic bilateral stent-in-stent placement with ...
23601439 - A simple two-stage "bailout" technique for the removal of an unyielding ureteric stent.
19468739 - Long-term results of endonasal dacryocystorhinostomy.
22632709 - Total joint arthroplasty for persons with osteoarthritis.
23804729 - Reoperations after repair of partial and complete atrioventricular septal defect.
12968119 - The experience of manual lymph drainage as an aspect of treatment for lymphoedema.
20837259 - Ed crowding is associated with an increased time to pneumonia treatment.
14695719 - Noninvasive positive pressure ventilation using a helmet in patients with acute exacerb...
21756569 - Treatment of pressure ulcers with autologous bone marrow nuclear cells in patients with...
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-29
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  -     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Department of Adult Cardiac Surgery, Royal Brompton Hospital, London, UK.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Mitral valve surgery: wait and see vs. early operation.
Next Document:  The Tom40 assembly process probed using the attachment of different intramitochondrial sorting signa...