Residual and Progressive Aortic Regurgitation After Valve-Sparing Root Replacement: A Propensity-Matched Multi-Institutional Analysis in 764 Patients
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Residual and Progressive Aortic Regurgitation After Valve-Sparing Root Replacement: A Propensity-Matched Multi-Institutional Analysis in 764 Patients. / Kari, Fabian A; Doll, Kai-Nicolas; Hemmer, Wolfgang; Liebrich, Markus; Sievers, Hans-Hinrich; Richardt, Doreen; Reichenspurner, Hermann; Detter, Christian; Siepe, Matthias; Czerny, Martin; Beyersdorf, Friedhelm.
In: ANN THORAC SURG, Vol. 101, No. 4, 04.2016, p. 1500-1506.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Residual and Progressive Aortic Regurgitation After Valve-Sparing Root Replacement: A Propensity-Matched Multi-Institutional Analysis in 764 Patients
AU - Kari, Fabian A
AU - Doll, Kai-Nicolas
AU - Hemmer, Wolfgang
AU - Liebrich, Markus
AU - Sievers, Hans-Hinrich
AU - Richardt, Doreen
AU - Reichenspurner, Hermann
AU - Detter, Christian
AU - Siepe, Matthias
AU - Czerny, Martin
AU - Beyersdorf, Friedhelm
N1 - Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
PY - 2016/4
Y1 - 2016/4
N2 - BACKGROUND: Residual/progressive aortic regurgitation (rAR, pAR) after valve-sparing aortic root replacement (V-SARR) can lead to reoperations. We sought to characterize risk factors of mild rAR and pAR after V-SARR in a multicenter cohort. The effect of additional cusp repair on valve function was analyzed using propensity matching.METHODS: A total of 1,015 patients after V-SARR were identified with (n = 288, 28%) or without additional cusp/commissure repair (n = 727, 72%) at four cardiac units in Germany. A total of 764 patients fulfilling transthoracic echocardiography follow-up-criteria comprised the study cohort. Logistic regression was used for risk factor analysis with endpoints rAR, new onset AR, and pAR. t tests and analyses of variance were used for between-group differences. The effects of additional cusp repair on valve function were studied comparing propensity-matched quintiles.RESULTS: The incidence of rAR was 29%, with influencing factors aneurysm size (p = 0.07) and preoperative aortic valve function (p = 0.08). It was found more often among nonsyndromic patients (34% vs. 14%; OR, 0.4; p < 0.001). Progression of rAR was detectable in 30% after a mean of 4.3 years. The progression rate of rAR ∼ 0.3 grades per patient-year within the first 5 years. When quintiles identified by propensity score were compared, additional cusp repair was linked to new onset AR (p = 0.016) while it was not linked to rAR (p = 0.14) or pAR (p = 0.5).CONCLUSIONS: The incidences of rAR and pAR are considerable after V-SARR. Patients should be operated on before large aneurysms are present. New onset AR after an initially good functional result is more likely after an additional cusp repair, while rAR and pAR are not influenced by cusp repair.
AB - BACKGROUND: Residual/progressive aortic regurgitation (rAR, pAR) after valve-sparing aortic root replacement (V-SARR) can lead to reoperations. We sought to characterize risk factors of mild rAR and pAR after V-SARR in a multicenter cohort. The effect of additional cusp repair on valve function was analyzed using propensity matching.METHODS: A total of 1,015 patients after V-SARR were identified with (n = 288, 28%) or without additional cusp/commissure repair (n = 727, 72%) at four cardiac units in Germany. A total of 764 patients fulfilling transthoracic echocardiography follow-up-criteria comprised the study cohort. Logistic regression was used for risk factor analysis with endpoints rAR, new onset AR, and pAR. t tests and analyses of variance were used for between-group differences. The effects of additional cusp repair on valve function were studied comparing propensity-matched quintiles.RESULTS: The incidence of rAR was 29%, with influencing factors aneurysm size (p = 0.07) and preoperative aortic valve function (p = 0.08). It was found more often among nonsyndromic patients (34% vs. 14%; OR, 0.4; p < 0.001). Progression of rAR was detectable in 30% after a mean of 4.3 years. The progression rate of rAR ∼ 0.3 grades per patient-year within the first 5 years. When quintiles identified by propensity score were compared, additional cusp repair was linked to new onset AR (p = 0.016) while it was not linked to rAR (p = 0.14) or pAR (p = 0.5).CONCLUSIONS: The incidences of rAR and pAR are considerable after V-SARR. Patients should be operated on before large aneurysms are present. New onset AR after an initially good functional result is more likely after an additional cusp repair, while rAR and pAR are not influenced by cusp repair.
KW - Adult
KW - Aged
KW - Aorta, Thoracic/surgery
KW - Aortic Valve/surgery
KW - Aortic Valve Insufficiency/diagnostic imaging
KW - Blood Vessel Prosthesis Implantation/adverse effects
KW - Cardiac Valve Annuloplasty/methods
KW - Case-Control Studies
KW - Disease Progression
KW - Echocardiography/methods
KW - Female
KW - Follow-Up Studies
KW - Germany
KW - Heart Valve Prosthesis Implantation/adverse effects
KW - Humans
KW - Logistic Models
KW - Male
KW - Middle Aged
KW - Multivariate Analysis
KW - Organ Sparing Treatments/methods
KW - Propensity Score
KW - Recurrence
KW - Reoperation/methods
KW - Replantation/methods
KW - Retrospective Studies
KW - Risk Assessment
KW - Severity of Illness Index
KW - Statistics, Nonparametric
KW - Survival Rate
KW - Treatment Outcome
U2 - 10.1016/j.athoracsur.2015.10.002
DO - 10.1016/j.athoracsur.2015.10.002
M3 - SCORING: Journal article
C2 - 26704413
VL - 101
SP - 1500
EP - 1506
JO - ANN THORAC SURG
JF - ANN THORAC SURG
SN - 0003-4975
IS - 4
ER -
