Outcomes of surgical bioprosthetic aortic valve replacement for aortic insufficiency

Danial, Pichoy; Girdauskas, Evaldas; Aissani, Anissa; Debauchez, Matthieu; Lebreton, Guillaume; Leprince, Pascal; Reichenspurner, Hermann; Petersen, Johannes; Lansac, Emmanuel

doi:10.1016/j.acvd.2022.08.001

Cited by 3 publications

(3 citation statements)

References 31 publications

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“…Our short‐ and long‐term postoperative event rate was not insignificant and was similar to previous reports. 16 , 28 A recent German study of 289 patients operated on for AR (median age 57 years) reported a freedom from severe valve deterioration at 10 years of 73.3% and rate of IE at 10 years of 6.2%. 28 Moreover, the overall freedom from aortic reintervention was 87.4% at 10 years, although no patients older than 60 years were reoperated.…”

Section: Discussionmentioning

confidence: 99%

“… 16 , 28 A recent German study of 289 patients operated on for AR (median age 57 years) reported a freedom from severe valve deterioration at 10 years of 73.3% and rate of IE at 10 years of 6.2%. 28 Moreover, the overall freedom from aortic reintervention was 87.4% at 10 years, although no patients older than 60 years were reoperated. These data support our results and highlight the fact that younger patients are more likely to experience prosthetic valve degeneration and need additional interventions; this should be considered when deciding on the timing of intervention in patients with AR.…”

Section: Discussionmentioning

confidence: 99%

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Repair of Aortic Regurgitation in Young Adults: Sooner Rather Than Later

Barradas‐Pires,

Merás,

Constantine

et al. 2023

JAHA

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Background Establishing surgical criteria for aortic valve replacement (AVR) in severe aortic regurgitation in young adults is challenging due to the lack of evidence‐based recommendations. We studied indications for AVR in young adults with severe aortic regurgitation and their outcomes, as well as the relationship between presurgical echocardiographic parameters and postoperative left ventricular (LV) size, function, clinical events, and valve‐related complications. Methods and Results Data were collected retrospectively on 172 consecutive adult patients who underwent AVR or repair for severe aortic regurgitation between 2005 and 2019 in a tertiary cardiac center (age at surgery 29 [22–41] years, 81% male). One‐third underwent surgery before meeting guideline indications. Postsurgery, 65% achieved LV size and function normalization. LV ejection fraction showed no significant change from baseline. A higher presurgical LV end‐systolic diameter correlated with a lack of LV normalization (odds ratio per 1‐cm increase 2.81, P <0.01). The baseline LV end‐systolic diameter cut‐off for predicting lack of LV normalization was 43 mm. Pre‐ and postoperative LV dimensions and postoperative LV ejection fraction predicted clinical events during follow‐up. Prosthetic valve‐related complications occurred in 20.3% during an average 5.6‐year follow‐up. Freedom from aortic reintervention was 98%, 96.5%, and 85.4% at 1, 5, and 10 years, respectively. Conclusions Young adult patients with increased baseline LV end‐systolic diameter or prior cardiac surgery are less likely to achieve LV normalization after AVR. Clinicians should carefully balance the long‐term benefits of AVR against procedural risks and future interventions, especially in younger patients. Evidence‐based criteria for AVR in severe aortic regurgitation in young adults are crucial to improve outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Repair of Aortic Regurgitation in Young Adults: Sooner Rather Than Later

Barradas‐Pires,

Merás,

Constantine

et al. 2023

JAHA

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“…As a result, aortic valve repair using the re-implantation technique or remodelling with aortic annuloplasty, is recommended in young patients with aortic root dilatation and tricuspid aortic valve (Class IC indication) since 2014 ESC/EACTS guidelines ( 2 ). However, most aortic valves are still replaced ( 3 ). The multicentric CAVIAAR study comparing aortic valve repair versus mechanical valve replacement for root aneurysm showed that standardized aortic valve repair with external annuloplasty significantly reduced valve-related deaths and major bleeding rates without increasing the risk of reoperation ( 4 ).…”

Section: Commentsmentioning

confidence: 99%

Annular stabilization in remodelling technique

Danial¹,

Youssefi²,

Debauchez³

et al. 2023

Ann Cardiothorac Surg

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Case 1 is a 52-year-old patient with New York Heart Association (NYHA) III dyspnea. Echocardiography demonstrated a tricuspid aortic valve with grade 4 aortic insufficiency (AI), preserved ejection fraction (50%) and a dilated left ventricle with end-diastolic and end-systolic diameters of 63 and 42 mm, respectively. Gated computed tomography (CT) revealed sinuses of Valsalva measuring 57 mm and ascending aorta 44 mm in diameter.Case 2 is a 69-year-old patient with NYHA III dyspnea. Echocardiography demonstrated a bicuspid aortic valve with grade 4 AI, preserved ejection fraction (54%) and a dilated left ventricle with end-diastolic and end-systolic diameters of 59 and 45 mm, respectively. Gated CT revealed sinuses of Valsalva measuring 52 mm and ascending aorta 47 mm in diameter. Surgical techniques PreparationAfter performing a median sternotomy and opening the pericardium, heparinization is undertaken. To maximize the excised ascending aorta length, aorta cannulation is performed high in the arch. Direct antegrade Custodial cardioplegia is used to induce diastolic arrest. OperationThe ascending aorta is opened and excised down to the sinotubular junction. To reach below the level of the

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