Imaging characteristics, and long term outcomes of surgical management for pannus overgrowth after mechanical aortic valve replacement

Abstract

Background: Endocardial proliferation or pannus is uncommon after aortic valve replacement. This study aimed to determine the imaging characteristics, the risk factors and evaluate the long-term results of surgical treatment for these patients.
 Material and methods: a retrospective review of patients with confirmed intraoperative pannus diagnosis following mechanical aortic replacement.
 Results: There have 102 patients (mean age 48 and 71 women) who were re-operated for pannus. The image of “pannus” seen on echocardiography and valve dysfunction on fluoroscopy is positive in over 90% of cases. Female sex (OR=2.1, P=0.01) and both aortic and mitral valve replacement at first surgery (OR=2.98; P = 0.001) have a higher risk of pannus. Surgical procedures included pannus resection only or aortic replacement with a new valve and resect pannus or resect pannus, aortic replacement with aortic annulus enlargement. 30-day mortality was 1 case; atrioventricular block required permanent pace marker: 2 cases. The mean follow-up time for the second operation was 55.3 ± 48.8 months (2 cases lost of follow-up), recurrent pannus occurred in 5 cases, and no late death.
 Conclusion: The female patients and previously aortic combined with mitral replacement are a risks factor for pannus. Echocardiography combined with fluoroscopy could be identified as the diagnosis of pannus. The long-term outcomes of surgery for pannus are very good. Completely resect the pannus and replace it with the new valve is the method of choice instead of simply resecting the pannus to prevent recurrent pannus.