Effects of Preoperative Aortic Insufficiency on Outcome After Aortic Valve-Sparing Surgery

[摘要] Background-The presence of significant preoperative aortic insufficiency (AI) or the need for cusp repair has been suggested as a risk factor for poorer outcomes after aortic valve (AV)-sparing surgery. We analyzed the influence of these factors on the mid-term outcomes of AV surgery. Methods and Results-Between 1996 and 2008, 164 consecutive patients underwent elective AV-sparing surgery. Severe preoperative AI (grade >= 3+) was present in 93 patients (57%), and 54 (33%) had a bicuspid valve. Root repair was performed with either the reimplantation (74%) or the remodeling (26%) technique, and cusp repair was performed in 90 patients (55%). Mean clinical follow-up was 57 months. Hospital mortality was 0.6%. Cusp repair was required in 52% of the patients with preoperative AI <= 2+ and in 57% of those with AI >= 3+ (P=0.6). Cusp repair was required more frequently in bicuspid versus tricuspid valves (91% versus 38%, P<0.001). Overall survival at 8 years was 88 +/- 8%. Freedom from AV reoperation at 8 years was similar with preoperative AI <= 2+ versus preoperative AI >= 3+ (89 +/- 11% versus 90 +/- 7%, P=0.7) and with versus without cusp repair (84 +/- 17% versus 92 +/- 8%, P=0.5). Freedom from recurrent AI (grade >= 3+) at 5 years was also similar between groups (90 +/- 10% versus 89 +/- 8%, P=0.9, and 90 +/- 8% versus 89 +/- 9%, P=0.8, respectively). By multivariate analyses, predictors of recurrent AI >= 2+ were preoperative left ventricle end-diastolic diameter and AI >1+ on discharge echocardiography. Conclusions-With a systematic approach to cusp assessment and repair, AV-sparing surgery for root pathology has an acceptable mid-term outcome, irrespective of preoperative AI or need for cusp repair. (Circulation. 2009; 120[suppl 1]: S120-S126.)

[效力级别]  Proceedings Paper

[关键词] REPAIR;REIMPLANTATION;REPLACEMENT;EXPERIENCE;OPERATIONS;PROLAPSE;SIZE