Early outcomes of aortic valve repair versus replacement for aortic regurgitation: a single-center experience

CARDIOTHORACIC SURGEON - Tập 30 Số 1 - 2022
Mohamed A. Amr1, Elsayed A Fayad1
1Faculty of Medicine, Suez Canal University, Ismailia, Egypt

Tóm tắt

Abstract Background

Aortic valve repair in rheumatic patients is not well-studied. We aimed to present our initial Egyptian experience in the aortic valve repair and compare it with the aortic valve replacement. The study included 85 patients who had an aortic valve surgery for aortic regurgitation (AR) in a single center from 2018 to 2020. We assigned the patients to either aortic valve repair (n= 39) or aortic valve replacement (n= 46). Fifty-nine patients (69.4%) had rheumatic heart disease. Study outcomes were hospital complications and the degree of aortic regurgitation after 6 months in patients who had aortic valve repair.

 Results

Patients who had replacement were significantly older (49.6± 7.2 vs. 43.8± 8.6 years: P= 0.002) and had more advanced New York Heart Association (P<0.001) and Canadian Cardiovascular Scoring (P= 0.03) classes. Hypertension (31 (67.4%) vs. 17 (43.6%); P= 0.03) and hypercholesteremia (18 (40%) vs. 17 (18.9%); P= 0.04) were more common in the replacement group. Patients who had replacement had a significantly higher percentage of valve retraction (P<0.001). Cardiopulmonary bypass (54.5 (49.5–60) vs. 45 (41–49) min; P<0.001) and ischemic times (36.5 (31–40) vs. 30 (28–33) min; P<0.001) were longer in patients who had an aortic valve replacement. Blood transfusion (28 (60.9%) vs. 11 (282%); P= 0.003) and ICU stay (24.5 (24–48) vs 23 (20–31) h; P= 0.01) were higher in the replacement group. Hospital mortality was non-significantly different between groups. Four patients had trivial AR (10.3%), and six had mild AR (15.4%) in the repair group. There was no difference in valve pathology or outcomes in aortic valve repair patients for degenerative versus rheumatic pathologies. After a 6-month follow-up, four patients had trivial AR (10.3%), and six patients had mild AR (15.4%) in the repair group.

 Conclusions

Aortic valve repair could be an alternative to replacement in selected patients with rheumatic heart disease. Shorter cardiopulmonary bypass and ischemic times may improve repair outcomes compared to replacement.

Từ khóa


Tài liệu tham khảo

Lansac E, Di Centa I, Sleilaty G, Lejeune S, Khelil N, Berrebi A et al (2016) Long-term results of external aortic ring annuloplasty for aortic valve repair. Eur J cardio-thoracic Surg Off J Eur Assoc Cardio-thoracic Surg 50(2):350–360

Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ et al (2017) 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 38(36):2739–2791 Available from: https://doi.org/10.1093/eurheartj/ehx391

Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J et al (2021) 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J cardio-thoracic Surg Off J Eur Assoc Cardio-thoracic Surg 60(4):727–800

de Kerchove L, Mastrobuoni S, Boodhwani M, Astarci P, Rubay J, Poncelet A et al (2016) The role of annular dimension and annuloplasty in tricuspid aortic valve repair. Eur J Cardio-Thorac Surg Off J Eur Assoc Cardio-thoracic Surg 49(2):428

Lansac E, de Kerchove L (2018) Aortic valve repair techniques: state of the art. Eur J Cardiothorac Surg 53:1101–1107

Yacoub M, Mayosi B, ElGuindy A, Carpentier A, Yusuf S (2017) Eliminating acute rheumatic fever and rheumatic heart disease. Lancet (London, England) 390(10091):212–213

Afifi A, Hosny H, Yacoub M (2019) Rheumatic aortic valve disease-when and who to repair? Ann Cardiothorac Surg 8(3):383–389

d'Udekem Y, Sharma V (2013) Repair options in rheumatic aortic valve disease in young patients: potential problems with pericardial cusp extension. World J Pediatr Congenit Heart Surg 4(4):392–396

Schneider U, Hofmann C, Aicher D, Takahashi H, Miura Y, Schäfers H-J (2017) Suture Annuloplasty significantly improves the durability of bicuspid aortic valve repair. Ann Thorac Surg 103(2):504–510

Przybylski R, Pawlak S, Śliwka J, Urlik M, Maruszewski M, Kukulski T et al (2015) Aortic cusp extension valvuloplasty: repair with an extracellular patch. Kardiochirurgia i Torakochirurgia Pol = Polish J Cardio-Thorac Surg 12(4):314–317

de Kerchove L, Boodhwani M, Glineur D, Vandyck M, Vanoverschelde J-L, Noirhomme P et al (2011) Valve sparing-root replacement with the reimplantation technique to increase the durability of bicuspid aortic valve repair. J Thorac Cardiovasc Surg 142(6):1430–1438

le Polain de Waroux J-B, Pouleur A-C, Goffinet C, Vancraeynest D, Van Dyck M, Robert A et al (2007) Functional anatomy of aortic regurgitation: accuracy, prediction of surgical repairability, and outcome implications of transesophageal echocardiography. Circulation. 116(11 Suppl):I264–I269

Regeer MV, Versteegh MIM, Klautz RJM, Stijnen T, Schalij MJ, Bax JJ et al (2015) Aortic valve repair versus replacement for aortic regurgitation: effects on left ventricular remodeling. J Card Surg 30(1):13–19

Mayer K, Aicher D, Feldner S, Kunihara T, Schäfers H-J (2012) Repair versus replacement of the aortic valve in active infective endocarditis. Eur J cardio-thoracic Surg Off J Eur Assoc Cardio-thoracic Surg 42(1):122–127

Thông tin
Thông tin xuất bản

CARDIOTHORACIC SURGEON

Tập 30 Số 1

Thông tin tác giả