Document Detail

Replacement of the proximal aorta adds no further risk to aortic valve procedures.
MedLine Citation:
PMID:  17643618     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Aortic valve pathology is often associated with proximal aortic dilatation. Even after valve surgery, the proximal aorta can continue to dilate and thus be at risk for rupture, dissection, or later aortic replacement. We hypothesized that the addition of proximal aortic intervention adds no further risk to aortic valve surgery, which may avoid subsequent proximal aortic procedures or catastrophes. METHODS: Between 1996 and 2004, 430 aortic valve interventions alone and 146 aortic valves with proximal aortic replacements were identified in elective adult patients. The age in the valve-alone patients (68.8 years) was slightly higher than the valve-plus-aorta group (valve/aorta, 60.5 years; p < 0.01), but comorbidities were similar between groups. We compared groups based on hospital mortality and incidence of complications. RESULTS: The 30-day mortality was similar between groups (valve-alone, 3.8% versus valve/aorta, 2.7%; p = 0.5), as were rates for bleeding and operative revision (valve-alone, 6.7% versus valve/aorta, 9.5%; p = 0.5). Pulmonary (valve-alone, 23.0% versus valve/aorta, 11.6%) and renal complications (valve-alone, 8.2% versus valve/aorta, 2.7%) were higher in the valve-alone group (p = 0.02). Logistic regression demonstrated no additional risk of death, neurologic, or cardiac event with replacement of the proximal aorta. CONCLUSIONS: Proximal aortic replacement adds no risk to the patient beyond the aortic valve intervention alone. These findings suggest proximal aortic replacement is safe for patients undergoing valve operations. Patients with a moderately enlarged proximal aorta that may dilate further should also be considered for aortic replacement at the time of valve procedures.
T Brett Reece; R Ramesh Singh; Brendon M Stiles; Benjamin B Peeler; John A Kern; Curtis G Tribble; Irving L Kron
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  84     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-07-23     Completed Date:  2007-08-17     Revised Date:  2008-04-16    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  473-8; discussion 478     Citation Subset:  AIM; IM    
Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Virginia, USA.
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MeSH Terms
Aorta, Thoracic / surgery*
Aortic Valve / surgery*
Cardiac Surgical Procedures / statistics & numerical data*
Coronary Artery Bypass
Heart Diseases / epidemiology
Heart Valve Prosthesis Implantation / mortality,  statistics & numerical data*
Hospital Mortality
Middle Aged
Nervous System Diseases / epidemiology
Postoperative Complications / classification,  epidemiology
Survival Analysis
Comment In:
Ann Thorac Surg. 2008 Apr;85(4):1502-3; author reply 1503   [PMID:  18355574 ]

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