German Aortic Root Repair Registry-Insights From the First 400 Consecutive Patients
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German Aortic Root Repair Registry-Insights From the First 400 Consecutive Patients. / Kari, Fabian A; Misfeld, Martin; Borger, Michael; Rylski, Bartosz; Zimmer, Emmanuel; Siepe, Matthias; Hagl, Christian; Detter, Christian; Petersen, Johannes; Tsvelodub, Stanislav; Richardt, Doreen; Werner, Paul; Andreas, Martin; Pichlmaier, Maximilian; Mueller, Christoph S.
In: ANN THORAC SURG, Vol. 113, No. 2, 02.2022, p. 608-615.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - German Aortic Root Repair Registry-Insights From the First 400 Consecutive Patients
AU - Kari, Fabian A
AU - Misfeld, Martin
AU - Borger, Michael
AU - Rylski, Bartosz
AU - Zimmer, Emmanuel
AU - Siepe, Matthias
AU - Hagl, Christian
AU - Detter, Christian
AU - Petersen, Johannes
AU - Tsvelodub, Stanislav
AU - Richardt, Doreen
AU - Werner, Paul
AU - Andreas, Martin
AU - Pichlmaier, Maximilian
AU - Mueller, Christoph S
N1 - Copyright © 2022 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
PY - 2022/2
Y1 - 2022/2
N2 - BACKGROUND: The objective was to provide initial data from our prospective valve-sparing aortic root replacement (V-SARR) registry and reasons for conversion to prosthetic aortic valve replacement.METHODS: Six centers established an intention-to-treat-design V-SARR-registry (the German Aortic Root Repair Registry; first patient in October 2016); the main inclusion criterion was being scheduled for V-SARR as plan A. Clinical information, operative details, intraoperative valve/root measurements, and clinical and transthoracic echocardiography follow-up-data are documented.RESULTS: Of a total of 449 patients, we report data for 401 (81% male; mean age 51 ± 14 years). Overall, 350 patients underwent V-SARR as scheduled, group A (David variants I 55%, III 2%, IV 13%, V 24%, V-Stanford 2%, and Yacoub remodeling 2%); and 51 were converted to aortic valve replacement (group B). Median follow-up was 11 months (range, 0 to 2.6 years), cumulative follow-up was 279 patient-years. In group B, there were fewer connective tissue disorders (6% vs 16%), fewer patients had left ventricular ejection fraction greater than 50% (60% vs 90%), more had bicuspid aortic valves (45% vs 28%), and fewer patients had preoperative none/trace aortic regurgitation (2% vs 20%). Fewer patients in group B had rare types of bicuspid aortic valve (fused N/L, R/N, 10% vs 30%) and more had unbalanced roots (56% vs 40%). Immediate postoperative aortic regurgitation was none/trace in 79% and mild in 20%. At 30 days, the mean transvalvular pressure gradient was 7 ± 5 mm Hg. None of the patients died in hospital; two strokes occurred. One patient needed early aortic valve replacement as redo surgery.CONCLUSIONS: The main factors causing surgeons to convert a planned V-SARR to aortic valve replacement include asymmetry of aortic valve/root, severity of aortic regurgitation, safety reasons (left ventricular ejection fraction), and bicuspid aortic valves (but not rare types). The German Aortic Root Repair Registry will help us identify the impact on long-term outcomes of preoperative and postoperative valvular anatomy and various V-SARR types.
AB - BACKGROUND: The objective was to provide initial data from our prospective valve-sparing aortic root replacement (V-SARR) registry and reasons for conversion to prosthetic aortic valve replacement.METHODS: Six centers established an intention-to-treat-design V-SARR-registry (the German Aortic Root Repair Registry; first patient in October 2016); the main inclusion criterion was being scheduled for V-SARR as plan A. Clinical information, operative details, intraoperative valve/root measurements, and clinical and transthoracic echocardiography follow-up-data are documented.RESULTS: Of a total of 449 patients, we report data for 401 (81% male; mean age 51 ± 14 years). Overall, 350 patients underwent V-SARR as scheduled, group A (David variants I 55%, III 2%, IV 13%, V 24%, V-Stanford 2%, and Yacoub remodeling 2%); and 51 were converted to aortic valve replacement (group B). Median follow-up was 11 months (range, 0 to 2.6 years), cumulative follow-up was 279 patient-years. In group B, there were fewer connective tissue disorders (6% vs 16%), fewer patients had left ventricular ejection fraction greater than 50% (60% vs 90%), more had bicuspid aortic valves (45% vs 28%), and fewer patients had preoperative none/trace aortic regurgitation (2% vs 20%). Fewer patients in group B had rare types of bicuspid aortic valve (fused N/L, R/N, 10% vs 30%) and more had unbalanced roots (56% vs 40%). Immediate postoperative aortic regurgitation was none/trace in 79% and mild in 20%. At 30 days, the mean transvalvular pressure gradient was 7 ± 5 mm Hg. None of the patients died in hospital; two strokes occurred. One patient needed early aortic valve replacement as redo surgery.CONCLUSIONS: The main factors causing surgeons to convert a planned V-SARR to aortic valve replacement include asymmetry of aortic valve/root, severity of aortic regurgitation, safety reasons (left ventricular ejection fraction), and bicuspid aortic valves (but not rare types). The German Aortic Root Repair Registry will help us identify the impact on long-term outcomes of preoperative and postoperative valvular anatomy and various V-SARR types.
KW - Aorta, Thoracic/surgery
KW - Aortic Diseases/epidemiology
KW - Follow-Up Studies
KW - Forecasting
KW - Germany/epidemiology
KW - Humans
KW - Incidence
KW - Middle Aged
KW - Prospective Studies
KW - Registries
KW - Vascular Surgical Procedures/statistics & numerical data
U2 - 10.1016/j.athoracsur.2021.03.060
DO - 10.1016/j.athoracsur.2021.03.060
M3 - SCORING: Journal article
C2 - 33811887
VL - 113
SP - 608
EP - 615
JO - ANN THORAC SURG
JF - ANN THORAC SURG
SN - 0003-4975
IS - 2
ER -
