Abstract
IntroductionThe objective of this study was to evaluate whether a surgery with the use of valved conduit is capable of leading to better immediate and late results than those obtained by the valve-sparing aortic root reconstruction technique.MethodsBetween January 2002 and June 2016, 448 patients underwent aortic root reconstruction. These were divided into three groups according to the technique used: 319 (71.2%) patients received mechanical valved conduits, 49 (10.9%) received biological valved conduits, and 80 (17.9%) underwent the valve-sparing aortic root reconstruction technique. The results were examined by univariate and multivariate analyses of Cox proportional hazards models with multiple logistic regression.ResultsThe hospital mortality rate was 7.5%. The mortality rates were 8.2%, 12%, and 2.5% in the mechanical valved conduit, biological valved conduit, and aortic valve-sparing groups, respectively, with no significant difference between groups (P=0.1). Thromboembolic complications and reoperation-free survival were also similar (P=0.169 and P=0.688). However, valve-sparing aortic root replacement was superior in terms of long-term survival (P<0.001), hemorrhagic-free survival (P<0.001), and endocarditis-free survival (P=0.048). Multivariate analysis showed that the following aspects had an impact on mortality: age > 70 years (P<0.001; hazard ratio [HR] 1.05), preoperative acute kidney injury (P<0.0042; HR 2.9), diagnosis of dissection (P<0.01; HR 2.0), previous cardiac surgery (P<0.027; HR 2.3), associated coronary artery bypass grafting (P<0.038; HR 1.8), reoperation for postoperative tamponade (P<0.004; HR 2.2) and postoperative acute kidney injury (P<0.02; HR 3.35).ConclusionValve-sparing technique seems to be the operation of choice, whenever possible, for aortic root reconstruction.
Highlights
The objective of this study was to evaluate whether a surgery with the use of valved conduit is capable of leading to better immediate and late results than those obtained by the valve-sparing aortic root reconstruction technique
Through analysis of the results of different Aortic root replacement (ARR) techniques, the objective of this study was to evaluate whether operations involving the use of valved conduits lead to better immediate and late results than those obtained by the valve-sparing ARR technique
Data were obtained through retrospective analysis of a prospectively constructed database from the Aorta Group of the Instituto do Coração – InCor, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo
Summary
The objective of this study was to evaluate whether a surgery with the use of valved conduit is capable of leading to better immediate and late results than those obtained by the valve-sparing aortic root reconstruction technique. Aortic root replacement (ARR) surgery using a valved conduit, whether mechanical or biological, is still the most commonly used technique for the correction of diseases affecting this aortic segment[1]. Despite the longer durability of the new generation of bioprostheses available, there is a concern regarding the degeneration of the biological valve prostheses and the need for complex reoperation, which justifies the formal indication according to international guidelines in patients older than 70 years of age[3]. The complexity of the procedure and the need for adequate patient selection according to valvular pathology still limit this procedure for correction of aortic root diseases
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