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Surgery of the aortic root: should we go for the valve-sparing root reconstruction or the composite graft-valve replacement is still the first choice of treatment for these patients?

Lamana Fde A, Dias RR, Duncan JA, Faria LB, Malbouisson LM, Borges Lde F, Mady C, Jatene FB - Rev Bras Cir Cardiovasc (2015 Jul-Sep)

Bottom Line: There was a predominance of aneurysms over dissections (81% vs. 19%), with 7% being acute dissections.There was no difference for thromboembolism, endocarditis, and need of reoperation.The aortic root reconstruction with preservation of the valve should be the operation being performed for presenting lower late mortality and survival free of bleeding events.

View Article: PubMed Central - PubMed

Affiliation: Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR.

ABSTRACT

Objective: To compare the results of the root reconstruction with the aortic valve-sparing operation versus composite graft-valve replacement.

Methods: From January 2002 to October 2013, 324 patients underwent aortic root reconstruction. They were 263 composite graft-valve replacement and 61 aortic valve-sparing operation (43 reimplantation and 18 remodeling). Twenty-six percent of the patients were NYHA functional class III and IV; 9.6% had Marfan syndrome, and 12% had bicuspid aortic valve. There was a predominance of aneurysms over dissections (81% vs. 19%), with 7% being acute dissections. The complete follow-up of 100% of the patients was performed with median follow-up time of 902 days for patients undergoing composite graft-valve replacement and 1492 for those undergoing aortic valve-sparing operation.

Results: In-hospital mortality was 6.7% and 4.9%, respectively for composite graft-valve replacement and aortic valve-sparing operation (ns). During the late follow-up period, there was 0% moderate and 15.4% severe aortic regurgitation, and NYHA functional class I and II were 89.4% and 94%, respectively for composite graft-valve replacement and aortic valve-sparing operation (ns). Root reconstruction with aortic valve-sparing operation showed lower late mortality (P=0.001) and lower bleeding complications (P=0.006). There was no difference for thromboembolism, endocarditis, and need of reoperation.

Conclusion: The aortic root reconstruction with preservation of the valve should be the operation being performed for presenting lower late mortality and survival free of bleeding events.

No MeSH data available.


Related in: MedlinePlus

Survival curve of patients who underwent aortic root reconstruction via aorticvalve-sparing operation (AVS) and composite graftvalve replacement (CVR)techniques. 1B - Survival curve of propensity score matched patients whounderwent aortic root reconstruction.
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f01: Survival curve of patients who underwent aortic root reconstruction via aorticvalve-sparing operation (AVS) and composite graftvalve replacement (CVR)techniques. 1B - Survival curve of propensity score matched patients whounderwent aortic root reconstruction.

Mentions: Mortality during follow-up was higher in the CVR group (P=0.001).Looking at the survival curve, the benefit of aortic root reconstruction with AVSbecomes evident (Figures 1A and 1B).


Surgery of the aortic root: should we go for the valve-sparing root reconstruction or the composite graft-valve replacement is still the first choice of treatment for these patients?

Lamana Fde A, Dias RR, Duncan JA, Faria LB, Malbouisson LM, Borges Lde F, Mady C, Jatene FB - Rev Bras Cir Cardiovasc (2015 Jul-Sep)

Survival curve of patients who underwent aortic root reconstruction via aorticvalve-sparing operation (AVS) and composite graftvalve replacement (CVR)techniques. 1B - Survival curve of propensity score matched patients whounderwent aortic root reconstruction.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541781&req=5

f01: Survival curve of patients who underwent aortic root reconstruction via aorticvalve-sparing operation (AVS) and composite graftvalve replacement (CVR)techniques. 1B - Survival curve of propensity score matched patients whounderwent aortic root reconstruction.
Mentions: Mortality during follow-up was higher in the CVR group (P=0.001).Looking at the survival curve, the benefit of aortic root reconstruction with AVSbecomes evident (Figures 1A and 1B).

Bottom Line: There was a predominance of aneurysms over dissections (81% vs. 19%), with 7% being acute dissections.There was no difference for thromboembolism, endocarditis, and need of reoperation.The aortic root reconstruction with preservation of the valve should be the operation being performed for presenting lower late mortality and survival free of bleeding events.

View Article: PubMed Central - PubMed

Affiliation: Universidade Federal de Minas Gerais, Belo Horizonte, MG, BR.

ABSTRACT

Objective: To compare the results of the root reconstruction with the aortic valve-sparing operation versus composite graft-valve replacement.

Methods: From January 2002 to October 2013, 324 patients underwent aortic root reconstruction. They were 263 composite graft-valve replacement and 61 aortic valve-sparing operation (43 reimplantation and 18 remodeling). Twenty-six percent of the patients were NYHA functional class III and IV; 9.6% had Marfan syndrome, and 12% had bicuspid aortic valve. There was a predominance of aneurysms over dissections (81% vs. 19%), with 7% being acute dissections. The complete follow-up of 100% of the patients was performed with median follow-up time of 902 days for patients undergoing composite graft-valve replacement and 1492 for those undergoing aortic valve-sparing operation.

Results: In-hospital mortality was 6.7% and 4.9%, respectively for composite graft-valve replacement and aortic valve-sparing operation (ns). During the late follow-up period, there was 0% moderate and 15.4% severe aortic regurgitation, and NYHA functional class I and II were 89.4% and 94%, respectively for composite graft-valve replacement and aortic valve-sparing operation (ns). Root reconstruction with aortic valve-sparing operation showed lower late mortality (P=0.001) and lower bleeding complications (P=0.006). There was no difference for thromboembolism, endocarditis, and need of reoperation.

Conclusion: The aortic root reconstruction with preservation of the valve should be the operation being performed for presenting lower late mortality and survival free of bleeding events.

No MeSH data available.


Related in: MedlinePlus