Document Detail


Long-term survival after the Bentall procedure in 206 patients with bicuspid aortic valve.
MedLine Citation:
PMID:  17888968     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The recognition that patients with a bicuspid aortic valve (BAV) are at risk for aorta-related death (rupture or dissection) has favored composite aortic root replacement in BAV patients who undergo aortic valve replacement for valve dysfunction as well as in asymptomatic BAV patients with significant aortic root dilatation. We report the results of Bentall operations in 206 BAV patients during an 18-year interval. METHODS: Two hundred six BAV patients (mean, 53 +/- 14 years, 84% male) underwent composite aortic root replacement between September 1987 and May 2005. One hundred nine patients (53%) presented with aortic regurgitation, 24 patients (12%) presented with aortic stenosis, and 55 patients (26%) presented with combined aortic stenosis and aortic regurgitation. Median preoperative aortic diameter was 5.5 cm (range, 3 to 9 cm). Twenty-two patients (11%) underwent urgent or emergent procedures; 11 had acute type A dissection (5%). Sixty-one percent had a mechanical valve Bentall prosthesis; in 39%, a biologic valve was implanted. Thirty-two percent had concomitant procedures. RESULTS: Overall hospital mortality was 2.9% (n = 6), and stroke rate was 1.9% (n = 4). Risk factors for adverse outcome (death or stroke), which occurred in 4.8% (n = 10), were presence of clot or atheroma (p = 0.02) and age older than 65 years (p = 0.05). During a mean follow-up of 5.9 years (1,200 patient-years; range, 5 to 18 patient-years), no patient required ascending aortic reoperation. Long-term survival was 93% after 5 years and 89% after 10 years. Discharged patients enjoyed survival equivalent to a normal age- and sex-matched population and superior to survival reported for a series of patients with aortic valve replacement alone. CONCLUSIONS: In patients with BAV, the Bentall procedure has an operative mortality no worse than that for aortic valve replacement, with superior long-term survival and a lower rate of aortic reoperation.
Authors:
Christian D Etz; Tobias M Homann; Daniel Silovitz; David Spielvogel; Carol A Bodian; Maximilian Luehr; Gabriele DiLuozzo; Konstadinos A Plestis; Randall B Griepp
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  84     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-09-24     Completed Date:  2007-12-21     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1186-93; discussion 1193-4     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, New York, New York 10029, USA. christian.etz@mountsinai.org
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Aortic Valve / abnormalities,  surgery*
Bioprosthesis*
Cardiovascular Abnormalities / mortality,  surgery
Child
Child, Preschool
Cohort Studies
Female
Follow-Up Studies
Heart Function Tests
Heart Valve Diseases / congenital,  mortality,  surgery*
Heart Valve Prosthesis Implantation / methods*,  mortality*
Hospital Mortality / trends
Humans
Intraoperative Complications / mortality*
Male
Middle Aged
Postoperative Complications / mortality
Probability
Prosthesis Design
Retrospective Studies
Risk Assessment
Survival Analysis
Time Factors
Treatment Outcome

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


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