Document Detail


Outcomes of aortic valve repair according to valve morphology and surgical techniques.
MedLine Citation:
PMID:  22761124     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The aim of this study was to assess the impact of aortic valve morphology and different surgical aortic valve repair techniques on long-term clinical outcomes.
METHODS: Between February 2003 and May 2010, 216 patients with aortic insufficiency underwent aortic valve repair in our institution. Ages ranged between 26 and 82 years (mean 53 ± 15 years). Aortic valve dysfunctions, according to functional classification, were: type I in 55 patients (25.5%), type II in 126 (58.3%) and type III in 35 (16.2%). Sixty-six patients (27.7%) had a bicuspid valve. Aortic valve repair techniques included sub-commissural plasty in 138 patients, plication in 84, free-edge reinforcement in 80, resection of raphe plus re-suturing in 40 and the chordae technique in 52. Concomitant surgical procedures were CABG in 22 (10%) patients, mitral valve repair in 12 (5.5%), aortic valve-sparing re-implantation in 78 (36%) and ascending aorta replacement in 69 (32%). Mean follow-up was 42 ± 16 months and was 100% complete.
RESULTS: There were six early deaths (2.7%). Overall late survival was 91.5% (18 late deaths). There were 15 (6.9%) late cardiac-related deaths. NYHA functional class was ≤ II in all patients. At follow-up, 28 (14.5%) patients had recurrent aortic insufficiency ≥ grade II. The freedom from valve-related events was significantly different between bicuspid and tricuspid valve implantation (P < 0.01), between type I + II and type III (P < 0.001) dysfunction and between the chordae technique and plication, compared to free-edge reinforcement (P < 0.01). Statistically-significant differences were found between patients who underwent aortic valve repair plus root re-implantation, compared to those who underwent isolated aortic valve repair (P = 0.02).
CONCLUSIONS: Aortic valve repair including aortic annulus stabilization is a safe surgical option with either tricuspid or bicuspid valves; even more so if associated with root re-implantation. Patients with calcified bicuspid valves have poor results.
Authors:
Khalil Fattouch; Giacomo Murana; Sebastiano Castrovinci; Giuseppe Nasso; Claudia Mossuto; Egle Corrado; Giovanni Ruvolo; Giuseppe Speziale
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Publication Detail:
Type:  Comparative Study; Journal Article     Date:  2012-07-03
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  15     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-09-19     Completed Date:  2013-02-08     Revised Date:  2013-10-11    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  644-50     Citation Subset:  IM    
Affiliation:
Department of Cardiac Surgery, University of Palermo, Palermo, Italy. khalilfattouch@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Aorta / surgery
Aortic Valve / abnormalities,  surgery*,  ultrasonography
Aortic Valve Insufficiency / complications,  mortality,  surgery*,  ultrasonography
Blood Vessel Prosthesis Implantation
Calcinosis / complications,  mortality,  surgery*,  ultrasonography
Cardiac Valve Annuloplasty* / adverse effects,  mortality
Chordae Tendineae / surgery
Coronary Artery Bypass
Disease-Free Survival
Female
Hospital Mortality
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Mitral Valve / surgery
Proportional Hazards Models
Recurrence
Replantation
Risk Assessment
Risk Factors
Suture Techniques* / adverse effects,  mortality
Time Factors
Treatment Outcome
Comments/Corrections

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


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