Original article
Adult cardiac
Risk of Valve-Related Events After Aortic Valve Repair

Presented at the Forty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–Feb 1, 2012.
https://doi.org/10.1016/j.athoracsur.2012.07.016Get rights and content

Background

The impetus for aortic valve (AV) repair is to decrease valve-related complications in comparison to prosthetic valve replacement. However, relatively few data are available to confirm this hypothesis. We analyzed valve-related complications in a large series of patients undergoing AV repair.

Methods

Between 1995 and 2010, 475 patients underwent elective AV repair for aortic insufficiency or aortic aneurysm. The mean age was 53 years, and 81% were male. Valve-related outcomes were defined as per published guidelines. Survival and freedom from valve-related events were reported using the Kaplan-Meier method and linearized event rates. Clinical follow-up was 98.3% complete with a mean follow-up time of 4.6 years.

Results

Thirty-day mortality was 0.8% (n = 4). At 10 years, overall survival was 73% ± 5%, freedom from cardiac death was 81% ± 4%, and freedom from valve-related death was 90% ± 3%. Freedom from significant aortic insufficiency was 84% ± 3%. A total of 28 patients needed early (n = 7) or late (n = 21) AV reoperation; all of them survived reoperation, and 8 had repeat repair. Ten-year freedom from AV reoperation was 86% ± 3%, and freedom from AV replacement was 90% ± 3%. Freedom from AV reoperation was similar in tricuspid and bicuspid valve. During the follow-up period, linearized rate of thromboembolic event, bleeding, and AV endocarditis was 1.1%, 0.23%, and 0.19% per year, respectively. Ten-year freedom from valve-related events including AV reoperation, thromboembolic event, bleeding, and endocarditis was 74% ± 3%.

Conclusions

The current findings confirm that AV repair is associated with low mortality, acceptable durability, and a low risk of valve-related events.

Section snippets

Patient Population and Follow-Up

This study was approved by the institutional review board, and the need for individual informed consent was waived. Between 1995 and 2010, 475 patients underwent elective AV repair for aortic insufficiency (AI) or aortic root aneurysm. Patient demographics and operative data were collected prospectively in our institutional database and analyzed retrospectively. Clinical follow-up was conducted through either outpatient visits or telephone follow-up. Information on survival status,

Patient Characteristics, Short-Term Outcomes, and Survival

Patient characteristics are summarized in Table 1. The mean age was 53 years, and the majority of patients were male with normal left ventricular function. Aortic valve morphology was bicuspid in 34% of patients, and 58% had significant preoperative AI. Operative techniques and characteristics are displayed in Table 2. Aortic leaflet repair was performed in 71% of the patients, and an annuloplasty technique was used in 95%. Aortic valve-sparing root replacement was performed in 49% of repairs,

Comment

This study demonstrates that AV repair can be performed to treat multiple types of AV and aortic root disease with good mid-term survival, freedom from reoperation, and freedom from valve-related events. Specifically, at 10 years there was overall survival of 73% ± 5%, freedom from valve-related death of 90% ± 3%, freedom from significant AI of 84% ± 3 %, freedom from AV reoperation of 86 ± 3%, and freedom from valve-related events including AV reoperation, thromboembolic event, bleeding, and

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