A Decision Tree for the Replacement of the Ascending Aorta in Patients Undergoing Aortic Valve Surgery: A Single Center Experience in 1362 Patients

Background and Aims: It is not uncommon that patients requiring valve surgery have several simultaneous valvular dysfunctions. Combined aortic and mitral valve surgery is the most common form of double-valve surgery. The aim of this study was to analyze and present the outcomes of simultaneous aortic and mitral valve surgery in a single center in a real-life setting. Materials and Methods: The study population consisted of 150 patients operated in the Kuopio University Hospital from 2004 to 2020. All patients undergoing concomitant mitral and aortic valve surgery were included. Four groups were formed based on either the etiology or pathophysiology of the valvular dysfunction. The most common combination was mitral regurgitation with aortic regurgitation ( n = 72, 48%), followed by mitral regurgitation with aortic stenosis ( n = 37, 25%), endocarditis ( n = 29, 19%), and mitral stenosis with aortic regurgitation or stenosis ( n = 12, 8%). Concomitant coronary artery revascularization was performed in 37 (25%) patients and tricuspid valve repair in 26 (17%) patients. Results: Operative mortality was 2% and 30-day mortality was 7%. Overall survival was 86%, 78%, and 61% in 3, 5, and 10 years, respectively. Patients with endocarditis were significantly more morbid, and more often than other patients had to undergo an emergency operation. There were no significant differences between the groups in terms of early and late survival. In the overall cohort, the EuroSCORE II value, increased pulmonary artery pressure, decreased glomerular filtration, and length of the operation displayed a negative correlation with survival. Conclusion: Despite the challenging nature of multivalvular heart disease, surgery is a safe method of treatment with good short- and long-term outcomes.

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P912Outcomes of aortic valve surgery in non-stenotic valves: mechanical replacement versus repair

European Heart Journal ◽

10.1093/eurheartj/ehz747.0508 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Moreira ◽

J Quintal ◽

R J Cerqueira ◽

F A Saraiva ◽

A F Ferreira ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Disease ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Surgical Team ◽

Single Center ◽

Valve Repair ◽

Term Survival ◽

Repair Group

Abstract Background Considering selected patients and the expertise of the surgical team, aortic valve repair (REPAIR) has been recognized as an alternative to aortic valve replacement. Aim To compare mid-term survival, need of reoperation and hemodynamic results after mechanical replacement (MECH) or REPAIR in non-stenotic aortic valve disease. Methods Retrospective single-center cohort study including consecutive patients younger than 70 years-old, with non-stenotic aortic valve disease, who underwent 1st aortic valve surgery with MECH or REPAIR (2 experienced surgeons), during a 6-year period. Concomitant procedures were not excluded. First follow-up echocardiogram was performed within 3 months after surgery (median). Mean follow-up time was 4 years, maximum 7. According to the data distribution appropriate statistical tests to compare independent samples were used. Mid-term survival and need of reoperation were studied through Kaplan-Meier curves and Cox regression. Results MECH was performed in 94 (56.6%) and REPAIR in 72 patients. Individuals in MECH group were older and presented higher NYHA functional class than REPAIR group (51±11 vs 47±13 years, p=0.048; 30 vs 4%, p<0.001). MECH group presented higher prevalence of rheumatic etiology (17 vs 3%, p<0.001). Although aortic root intervention was more frequent in MECH group (41 vs 17%, p<0.001), there were no differences in cardiopulmonary bypass and cross clamping aortic times (166 vs 148 minutes, p=0.16; and 121 vs 108 minutes, p=0.15 in MECH and REPAIR group, respectively). Left ventricle mass regression was similar (18 vs 21%, p=0.450, in MECH and REPAIR group, respectively). Mid-term survival (REPAIR cumulative survival 97% and MECH 93%, Log-Rank test p=0.752) and reoperation rates were similar between the two groups. REPAIR procedure failed in 3 patients: 2 months (new aortic regurgitation, AR), 7 months (infective endocarditis, IE) and 4 years (AR). MECH failed in 2 patients: 6 months (IE) and 2 months after surgery (prosthesis thrombosis) (Figure 1). Conclusion Aortic valve repair seems to be safe and effective in this single-center study showing similar results comparing with mechanical aortic valve replacement. We should reinforce the need of judiciously select patients for this complex surgical technique and the specialized training of the surgical team. Further studies are needed to provide reliable recommendations on this theme.

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