Abstract
OBJECTIVES:The effect of performing aortic valve repair in combination with valve-sparing operation on the length of time for which patients are free from reoperation is unclear. The objective of this study was to determine if the performance of aortic valve repair during valve-sparing operation modified the freedom from reoperation time.METHODS:From January 2003 to July 2014, 78 patients with a mean age of 49±15 years underwent valve-sparing operation. Sixty-eight percent of these patients were male. Twenty-two (28%) aortic valve repair procedures were performed in this patient population. In the aortic valve repair + valve-sparing operation group, 77.3% of patients had moderate/severe aortic insufficiency, while in the valve-sparing operation group, 58.6% of patients had moderate/severe aortic insufficiency (ns = not significant). Additionally, 13.6% of patients in the aortic valve repair + valve-sparing operation group had functional class III/IV, while 14.2% of patients in the valve-sparing operation group had functional class III/IV (ns).RESULTS:The in-hospital and late mortality rates, for the aortic valve repair + valve-sparing operation and valve-sparing operation groups were similar, as they were 4.5% and 3.6%; and 0% and 1.8%, respectively. In the aortic valve repair + valve-sparing operation group, 0% of patients presented moderate/severe aortic insufficiency during late follow-up, while in the valve-sparing operation group, 14.2% of patients presented with moderate/severe aortic insufficiency during this period (ns). In the aortic valve repair + valve-sparing operation group, 5.3% of patients presented with functional class III/IV, while in the valve-sparing operation group, 4.2% of patients presented with functional class III/IV (ns). In the aortic valve repair + valve-sparing operation group, 0% of patients required reoperation, while in the valve-sparing operation group, 3.6% of patients required reoperation over a mean follow-up period of 1621±1156 days (75 patients).CONCLUSION:Valve-sparing operation is a safe and long-lasting procedure and performance of aortic valve repair when necessary does not increase risk of reoperation on the aortic valve.
Highlights
IntroductionThese authors found that there is a lack of information regarding the incidence and prevalence of thoracic aortic disease (TAD) disease, whose mortality rate is high
With the exception of age, as we observed that patients undergoing aortic valve repair (AVR) + valve-sparing operation (VSO) were older than patients undergoing VSO, the two groups were similar with respect to their clinical characteristics, such as their etiopathogenesis of aortic disease, their degrees of aortic insufficiency, their left ventricular ejection functions, their aortic sizes, their medical histories, their operative times and their associated procedures’s complexities (Tables 1 and 2)
VSO must be considered and performed, regardless of patient age and aortic disease etiopathogenesis, as the literature has consistently reported that patients who undergo VSO experience fewer complications related to anticoagulation or reoperations because of infection or prosthesis dysfunction than patients who undergo the Bentall procedure [6]
Summary
These authors found that there is a lack of information regarding the incidence and prevalence of TAD disease, whose mortality rate is high. They noticed that patients with TAD are extremely difficult to manage, since local centers are often unable to effectively treat these patients, the referral of affected patients to centers specializing in TAD treatment is inefficient and the results of treatment provided by the centers to which patients are referred are often suboptimal [2]
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