Factors Determining Outcomes of Aortic Valve Surgery in Patients with Aortic Regurgitation Due to Behçet's Disease: Impact of Preoperative Echocardiographic Features

Abstract

Paravalvular leakage after open heart surgery is notoriously common in patients with aortic regurgitation (AR) due to Behçet's disease. The aim of this study was to test whether initial echocardiographic findings are useful to predict recurrent AR. Lesion severity on preoperative echocardiography was scored for redundant aortic valve cusp (0-2points), aortic pseudoaneurysm (0-2 points), and dissection of the adjacent interventricular septum (0-2 points) in 22 patients with severe AR due to Behçet's disease (13 men; mean age, 42.4 ± 11.5 years), which was confirmed by histologic examination after open heart surgery. Recurrent AR developed in 13 patients at a median of 12.6 months (range, 2.4-70.3 months) after the first operation, and 10, four, and one patient underwent second, third, and fourth surgery, respectively, to control recurrent AR; three patients died. Those patients with recurrent AR had a significantly higher incidence of repeat surgery or death (84.6% [11 of 13] vs 0%, P= .015). Multivariate analysis showed that perioperative immunotherapy (hazard ratio, 0.002; 95% confidence interval, 0.001-0.1761; P= .006) and total echocardiographic score (hazard ratio, 2.843; 95% confidence interval, 1.350-5.991; P= .006) were independent factors associated with recurrent AR. The 1-year, 3-year, and 5-year AR-free survival rates were 73 ± 10%, 46 ± 12%, and 39 ± 12%. The optimal cutoff value for total echocardiographic score was 3.0, and the 5-year AR-free survival rates were significantly lower in patients with scores ≥ 3 (20 ± 13% vs 50 ± 19%, P= .022). This retrospective study confirms that initial echocardiographic features can provide useful prognostic information in patients with AR due to Behçet's disease.