Survival and freedom from aortic valve-related reoperation after valve-sparing aortic root replacement in 1015 patients
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Survival and freedom from aortic valve-related reoperation after valve-sparing aortic root replacement in 1015 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: INTERACT CARDIOV TH, Vol. 22, No. 4, 04.2016, p. 431-438.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Survival and freedom from aortic valve-related reoperation after valve-sparing aortic root replacement in 1015 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 - © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
PY - 2016/4
Y1 - 2016/4
N2 - OBJECTIVES: The aim of this study was to characterize mortality and aortic valve replacement after valve-sparing aortic root replacement (V-SARR) in a multicentre cohort.METHODS: Between 1994 and 2014, 1015 patients had V-SARR with (n = 288, 28%) or without cusp/commissure repair (n = 727, 72%) at the centres of Lübeck (n = 343, 34%), Stuttgart (n = 346, 34%), Hamburg (n = 109, 11%) and Freiburg (n = 217, 21%), Germany. Comparative survival of an age- and gender-matched general population was calculated. Log-rank tests and multiple logistic regression were used to identify risk factors.RESULTS: The mean follow-up was 5.2 ± 3.9 years. Cumulative follow-up comprised 2933 patient-years. Early survival was 98%. NYHA status and aneurysm size were predictive of death during mid-term follow-up (P = 0.025). Freedom from aortic valve replacement was 90% at 8 years, with the type of V-SARR (root remodelling, David II) being a risk factor (P = 0.015). Bicuspid aortic valve (P = 0.26) and initial valve function (P = 0.4) did not impact reoperation. The need of additional valve repair (cusps/commissures) was not linked to reoperation: freedom from aortic valve replacement at 8 years was 84% if cusp repair was performed versus 90% if V-SARR alone was performed (P = 0.218). Marfan syndrome had no impact on survival or on aortic valve replacement.CONCLUSIONS: Mid-term survival of patients after V-SARR is comparable with that of a matched general population. The regurgitant bicuspid aortic valve is a favourable substrate for V-SARR. Prophylactic surgery should be performed before symptoms or large aneurysms are present to achieve optimal mid-term outcomes.
AB - OBJECTIVES: The aim of this study was to characterize mortality and aortic valve replacement after valve-sparing aortic root replacement (V-SARR) in a multicentre cohort.METHODS: Between 1994 and 2014, 1015 patients had V-SARR with (n = 288, 28%) or without cusp/commissure repair (n = 727, 72%) at the centres of Lübeck (n = 343, 34%), Stuttgart (n = 346, 34%), Hamburg (n = 109, 11%) and Freiburg (n = 217, 21%), Germany. Comparative survival of an age- and gender-matched general population was calculated. Log-rank tests and multiple logistic regression were used to identify risk factors.RESULTS: The mean follow-up was 5.2 ± 3.9 years. Cumulative follow-up comprised 2933 patient-years. Early survival was 98%. NYHA status and aneurysm size were predictive of death during mid-term follow-up (P = 0.025). Freedom from aortic valve replacement was 90% at 8 years, with the type of V-SARR (root remodelling, David II) being a risk factor (P = 0.015). Bicuspid aortic valve (P = 0.26) and initial valve function (P = 0.4) did not impact reoperation. The need of additional valve repair (cusps/commissures) was not linked to reoperation: freedom from aortic valve replacement at 8 years was 84% if cusp repair was performed versus 90% if V-SARR alone was performed (P = 0.218). Marfan syndrome had no impact on survival or on aortic valve replacement.CONCLUSIONS: Mid-term survival of patients after V-SARR is comparable with that of a matched general population. The regurgitant bicuspid aortic valve is a favourable substrate for V-SARR. Prophylactic surgery should be performed before symptoms or large aneurysms are present to achieve optimal mid-term outcomes.
KW - Adult
KW - Aged
KW - Aorta/surgery
KW - Aortic Aneurysm/diagnosis
KW - Aortic Valve/surgery
KW - Aortic Valve Insufficiency/diagnosis
KW - Blood Vessel Prosthesis Implantation/adverse effects
KW - Disease-Free Survival
KW - Female
KW - Germany
KW - Heart Valve Prosthesis Implantation/adverse effects
KW - Humans
KW - Kaplan-Meier Estimate
KW - Logistic Models
KW - Male
KW - Middle Aged
KW - Multivariate Analysis
KW - Proportional Hazards Models
KW - Reoperation
KW - Replantation/adverse effects
KW - Retrospective Studies
KW - Risk Factors
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1093/icvts/ivv354
DO - 10.1093/icvts/ivv354
M3 - SCORING: Journal article
C2 - 26718320
VL - 22
SP - 431
EP - 438
JO - INTERACT CARDIOV TH
JF - INTERACT CARDIOV TH
SN - 1569-9293
IS - 4
ER -
