Mid-term outcomes of valve-sparing root reimplantation with leaflet repair

2020 ◽  
Vol 58 (1) ◽  
pp. 138-144
Author(s):  
Koki Yokawa ◽  
Soichiro Henmi ◽  
Hidekazu Nakai ◽  
Katsuhiro Yamanaka ◽  
Atsushi Omura ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Disease ◽  
Type I ◽  
Aortic Dilatation ◽  
Valve Repair ◽  
Clinical Trial Registration ◽  
Type Iii ◽  
Oriented System

Abstract OBJECTIVES Valve repair for aortic insufficiency (AI) requires a tailored surgical approach determined by the leaflet and aortic disease. In this study, we used a repair-oriented system for the classification of AI, and we elucidated long-term outcomes of aortic root reimplantation with this classification system. METHODS From 1999 to 2018, a total of 197 patients underwent elective reimplantation (mean age: 52.7 ± 17.7 years; 80% male). The aortic valve was tricuspid in 143 patients, bicuspid in 51 patients and quadricuspid in 3 patients. A total of 93 patients had type I AI (aortic dilatation), 57 patients had type II AI (cusp prolapse) and 47 patients had type III AI (restrictive). In total, 104 of the 264 patients (39%) had more than 1 identified mechanism. RESULTS In-hospital mortality was 0.5% (1/197). Mid-term follow-up (mean follow-up duration: 5.5 years) revealed a late mortality rate of 4.2% (9/197). Aortic valve reoperation was performed on 16 patients (8.0%). Rates of freedom from aortic valve replacement and freedom from aortic valve-related events at 10 years of follow-up were 87.0 ± 4.0% and 60.6 ± 6.0%, respectively; patients with type Ib AI (98.3 ± 1.7%; 80.7 ± 7.5%) had better outcomes than patients with type III AI (59.6 ± 15.6%; 42.2 ± 13.1%, P = 0.01). In patients with types II and III AI who had bicuspid aortic valves, rates of freedom from aortic valve-related events at 5 years of follow-up were 95.2 ± 4.7% and 71.7 ± 9.1%, respectively (P = 0.03). CONCLUSIONS This repair-oriented system for classifying AI could help to predict the durable aortic valve repair techniques. Patient selection according to the classification is particularly important for long-term durability. Clinical trial registration number B190050.

scholarly journals Ross procedure and aortic valve repair: long-term echocardiographic outcomes, quality of life and physical activity of different aortic valve surgery procedures

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
F Bianco ◽  
M Colaneri ◽  
V Bucciarelli ◽  
FC Surace ◽  
FC Iezzi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Aortic Valve ◽  
Aortic Surgery ◽  
Ross Procedure ◽  
Valve Repair ◽  
Sf 36

Abstract Funding Acknowledgements Type of funding sources: None. Background  To compare long-term outcomes of aortic valve repair (AVr) and pulmonary autograft replacement (Ross procedure) in terms of echocardiographic parameters, quality of life (QoL), physical activity (PA). Methods  In 2005-19, 129 patients (median age 22 [13, 33 IQR], 75% males) underwent aortic surgery in our Department: 40 were Ross (22 years [19, 51 IQR]), 67 AVr (17 years [1, 50 IQR]) and 22 aortic valve replacements (52 years [30, 80 IQR]). We focused on Ross and AVr. Retrospectively, relevant data were collected from medical records and phone re-calls. Physical activity (spontaneous and active) and QoL were assessed utilizing the IPAQ and SF-36 questionnaires. All patients underwent echocardiography pre/post-surgery and the follow-up lasted 12 ± 4 years. Results  At the baseline, Ross patients had more aortic stenosis than insufficiency (P = 0.045). At the follow-up, Ross procedures presented more right-ventricle and aortic annulus dilatation (P = 0.002 and P = 0.030, respectively), but higher left-ventricular global longitudinal strain (LV GLS: 18 ± 3.2 % vs. 16 ± 3.3, P = 0.0027). Conversely, AVr experienced more re-do operations (Log-rank P = 0.005). Ross reported better QoL (SF-36: 0.8 ± 0.07 vs. 19 ± 0.4, P-0.045) and were also more active in daily PA (IPAQ ≥ 2500 Mets: 63.8% vs. 6%; P = 0.006). Ross patients practiced more sports activities than AVr (P = 0.011). Conclusions  In a relatively small cohort of young and adults post aortic surgery patients, Ross procedures had better prognosis in terms of re-do operations; presented better ventricular function, as assessed by LV GLS. Ross patients had better long-term QoL and showed more spontaneous PA and involvement in sports activity.

scholarly journals Aortic valve repair with a newly approved geometric annuloplasty ring in patients undergoing proximal aortic repair: early results from a single-centre experience

2020 ◽  
Vol 57 (6) ◽  
pp. 1137-1144
Author(s):  
Oliver K Jawitz ◽  
Vignesh Raman ◽  
Jatin Anand ◽  
Muath Bishawi ◽  
Soraya L Voigt ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Transoesophageal Echocardiography ◽  
Aortic Disease ◽  
Aortic Insufficiency ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Annuloplasty Ring ◽  
Aortic Repair ◽  
Early Results

Abstract OBJECTIVES Aortic insufficiency (AI) is common in patients with proximal aortic disease, but limited options exist to facilitate aortic valve repair (AVr) in this population. This study reports ‘real-world’ early results of AVr using newly FDA-approved trileaflet and bicuspid geometric annuloplasty rings for patients with AI undergoing proximal aortic repair (PAR) in a single referral centre. METHODS All patients undergoing AVr with a rigid internal geometric annuloplasty ring (n = 47) in conjunction with PAR (ascending +/− root +/− arch) were included. Thirty-six patients underwent AVr with a trileaflet ring, and 11 patients underwent AVr with a bicuspid ring. The rings were implanted in the subannular position, and concomitant leaflet repair was performed if required for cusp prolapse identified after ring placement. RESULTS The median age was 58 years [interquartile range (IQR) 46–70]. PAR included supracoronary ascending replacement in 26 (55%) patients and remodelling valve-sparing root replacement with selective sinus replacement in 20 (42%) patients. Arch replacement was performed in 38 (81%) patients, including hemi-arch in 34 patients and total arch in 4 patients. There was no 30-day/in-hospital mortality. Preoperative AI was 3–4+ in 37 (79%) patients. Forty-one (87%) patients had zero–trace AI on post-repair transoesophageal echocardiography, and 6 patients had 1+ AI. The median early post-repair mean gradient was 13 mmHg (IQR 5–20). Follow-up imaging was available in 32 (68%) patients at a median of 11 months (IQR 10–13) postsurgery. AI was ≤1+ in 97% of patients with 2+ AI in 1 patient. All patients were alive and free from aortic valve reintervention at last follow-up. CONCLUSIONS Early results with geometric rigid internal ring annuloplasty for AVr in patients undergoing PAR appear promising and allow a standardized approach to repair with annular diameter reduction and cusp plication when needed. Longer-term follow-up will be required to ensure the durability of the procedure.

scholarly journals Long Term Comparative Follow-up of Patients with Type I and Type III MPGN† 1792

1998 ◽  
Vol 43 ◽  
pp. 305-305
Author(s):  
Michael C Braun ◽  
C Frederic Strife
Keyword(s):  
Type I ◽  
Type Iii

scholarly journals Phenotypes of Encapsulating Peritoneal Sclerosis—Macroscopic Appearance, Histologic Findings, and Outcome

2013 ◽  
Vol 33 (5) ◽  
pp. 495-502 ◽  
Author(s):  
Joerg Latus ◽  
Christoph Ulmer ◽  
Peter Fritz ◽  
Bianka Rettenmaier ◽  
Dagmar Biegger ◽  
...  
Keyword(s):  
Clinical Signs ◽  
Operation Time ◽  
Postoperative Treatment ◽  
Type I ◽  
Macroscopic Appearance ◽  
Type Iii ◽  
Significant Difference ◽  
Macroscopic Findings

BackgroundEncapsulating peritoneal sclerosis (EPS) is a rare but devastating complication of peritoneal dialysis (PD), with clinical signs of abdominal pain, bowel obstruction, and weight loss in late stages.MethodsWe retrospectively analyzed all patients who were diagnosed with EPS between March 1998 and October 2011 in our department of nephrology. We focused on the 24 EPS patients who underwent surgery because of symptomatic late-stage EPS. We identified 3 different macroscopic phenotypes of EPS that we categorized as types I – III. We correlated histologic findings with those macroscopic phenotypes of EPS. The postoperative and long-term outcomes were evaluated by macroscopic phenotype.ResultsDuration of PD was longer in type III than in types I and II EPS ( p = 0.05). We observed no other statistically significant differences between the groups in baseline characteristics, except for operation time, which was longer in the type I than in the type III group ( p = 0.02). Furthermore, we observed no statistically significant difference between the groups with respect to the onset of complaints before surgery (7.8 ± 5.9 months vs 7.0 ± 7.0 months vs 6.5 ± 5.3 months). Concerning patient outcomes, there was no evidence that any of the macroscopic EPS types was associated with more major or minor complications after surgery. For all study patients, follow-up was at least 3 years, with 19 patients still being alive, and 16 having no or very mild complaints. The typical histologic findings of EPS were present in all macroscopic types; only fibrin deposits were more prominent in type II than in type III.ConclusionsWe describe 3 subtypes of EPS based on macroscopic findings. Postoperative treatment should probably not be influenced by the macroscopic EPS phenotype. Whether the different phenotypes represent different pathophysiologic processes remains unclear and has to be further evaluated.

Predictors of Aortic Valve Repair Failure

2019 ◽  
Vol 14 (3) ◽  
pp. 199-208 ◽  
Author(s):  
Bobby Yanagawa ◽  
Amine Mazine ◽  
Ismail El-Hamamsy
Keyword(s):  
Aortic Valve ◽  
Three Dimensional ◽  
Major Complication ◽  
Aortic Insufficiency ◽  
Aortic Valve Repair ◽  
Valve Repair ◽  
Current State ◽  
Annular Dilation

Aortic valve repair is the preferred approach for the treatment of severe aortic insufficiency (AI), as it allows patients to keep their native aortic valve, thus substantially reducing the risk of prosthesis-related complications. Several studies have documented excellent long-term outcomes of aortic valve repair. The major complication of this operation is AI recurrence, with ensuingneed for reoperation. The surgical experience accumulated over the last two decades has allowed for better understanding of the mechanisms of recurrent AI after aortic valve repair. Herein, we review the current state of knowledge on predictors of aortic valve repair failure. These include unaddressed annular dilation, residual cusp prolapse or retraction, commissural orientation, and use of patch material. This enhanced understanding has led to the development of increasingly refined techniques and improved patient outcomes. Continued follow-up and detailed data collection at the time of surgery, together with three-dimensional echo imaging, will allow further improvements in aortic valve repair.

scholarly journals Bicuspid aortic valve repair: outcomes after 17 years of experience

2021 ◽  
Author(s):  
Marek J Jasinski ◽  
Kinga Kosiorowska ◽  
Radoslaw Gocol ◽  
Jakub Jasinski ◽  
Rafal Nowicki ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Left Ventricular ◽  
Aortic Valve Repair ◽  
Aortic Dilatation ◽  
Years Of Experience ◽  
Valve Repair ◽  
Sinotubular Junction ◽  
Reverse Remodelling

Abstract OBJECTIVES This study presents the results of 17 years of experience with bicuspid aortic valve (BAV) repair and the analysis of factors associated with repair failure and early echocardiographic outcome. METHODS Between 2003 and 2020, a total of 206 patients [mean age: 44.5 ± 15.2 years; 152 males (74%)] with BAV insufficiency with or without aortic dilatation underwent elective aortic valve repair performed by a single surgeon with a mean follow-up of 5 ± 3.5 years. The transthoracic echocardiography examinations were reported. RESULTS There were no deaths during the hospital stay, and all but 1 patient survived the follow-up period (99.5%). Overall, 10 patients (5%) developed severe insufficiency and 2 (1%) developed aortic dilatation requiring reoperation. Freedom from reoperation at 7 years reached 91.8%. Type 2 BAV configuration [hazard ratio (HR) 3.9; 95% confidence interval (CI): 1.01–60; P = 0.049], no sinotubular junction remodelling (HR 7; 95% CI: 1.7–23; P = 0.005), no circumferential annuloplasty (HR 3.9; 95% CI: 1.01–64; P = 0.047) and leaflet resection (HR 5.7; 95% CI 1.2–13. P = 0.017) have been identified as a risk factor of redo operation. Parameters of the postoperative left ventricle reverse remodelling improved significantly early after the operation and later at 2 years evaluation. CONCLUSIONS The repair of BAV offers good short- and mid-term results providing a significant reverse left ventricular remodelling. Type 0 BAV preoperative configuration, circumferential annuloplasty and sinotubular junction remodelling are associated with better repair durability.

Cranioplasty with autogenous bone flaps cryopreserved in povidone iodine: a long-term follow-up study

2017 ◽  
Vol 127 (6) ◽  
pp. 1449-1456 ◽  
Author(s):  
Jian Zhang ◽  
Fei Peng ◽  
Zhuang Liu ◽  
Jinli Luan ◽  
Xingming Liu ◽  
...  
Keyword(s):  
Bone Resorption ◽  
Povidone Iodine ◽  
Bone Flap ◽  
Autogenous Bone ◽  
Type I ◽  
Type Ii ◽  
Type Iii ◽  
Bone Flap Resorption

OBJECTIVEThe aim of this study was to investigate the long-term therapeutic efficacy of cranioplasty with autogenous bone flaps cryopreserved in povidone iodine and explore the risk factors for bone resorption.METHODSClinical data and follow-up results of 188 patients (with 211 bone flaps) who underwent cranioplasty with autogenous bone flaps cryopreserved in povidone-iodine were retrospectively analyzed. Bone flap resorption was classified into 3 types according to CT features, including bone flap thinning (Type I), reduced bone density (Type II), and osteolysis within the flaps (Type III). The extent of bone flap resorption was graded as mild, moderate, or severe.RESULTSShort-term postoperative complications included subcutaneous or extradural seroma collection in 19 flaps (9.0%), epidural hematoma in 16 flaps (7.6%), and infection in 8 flaps (3.8%). Eight patients whose flaps became infected and had to be removed and 2 patients who died within 2 years were excluded from the follow-up analysis. For the remaining 178 patients and 201 flaps, the follow-up duration was 24–122 months (mean 63.1 months). In 93 (46.3%) of these 201 flaps, CT demonstrated bone resorption, which was classified as Type I in 55 flaps (59.1%), Type II in 11 (11.8%), and Type III in 27 (29.0%). The severity of bone resorption was graded as follows: no bone resorption in 108 (53.7%) of 201 flaps, mild resorption in 66 (32.8%), moderate resorption in 15 (7.5%), and severe resorption in 12 (6.0%). The incidence of moderate or severe resorption was higher in Type III than in Type I (p = 0.0008). The grading of bone flap resorption was associated with the locations of bone flaps (p = 0.0210) and fragmentation (flaps broken into 2 or 3 fragments) (p = 0.0009). The incidence of bone flap collapse due to bone resorption was higher in patients who underwent ventriculoperitoneal (VP) shunt implantation than in those who did not (p = 0.0091).CONCLUSIONSBecause of the low incidence rates of infection and severe bone resorption, the authors conclude that cranioplasty with autogenous bone flaps cryopreserved in povidone-iodine solution is safe and effective. The changes characteristic of bone flap resorption became visible on CT scans about 2 months after cranioplasty and tended to stabilize at about 18 months postoperatively. The bone resorption of autogenous bone flap may be classified into 3 types. The rates of moderate and severe resorption were much higher in Type III than in Type I. The grade of bone flap resorption was associated with bone flap locations. Fragmented bone flaps or those implanted in patients treated with VP shunts may have a higher incidence of bone flap collapse due to bone resorption.

P3650Prognostic impact of post procedural aortic valve insufficiency on long-term risk for surgical aortic valve repair in patients undergoing balloon valvuloplasty for congenital aortic valve stenosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A S Pavlovic ◽  
S A Djordjevic ◽  
Z Mehmedbegovic ◽  
I Stefanovic ◽  
J Kalanj ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Stenosis ◽  
Aortic Valve Repair ◽  
Prognostic Impact ◽  
Valve Repair ◽  
Long Term Outcome ◽  
Increased Risk ◽  
Congenital Aortic Valve Stenosis

Abstract Background Limited evidence is available regarding the prognostic impact of post procedural aortic valve insufficiency (AVI) on long-term outcome in patients with congenital aortic valve stenosis treated with balloon aortic valvuloplasty (BAV). Purpose To assess the prognostic impact of immediate post procedural AVI on long-term outcome in patients undergoing BAV for congenital aortic valve stenosis. Methods We analyzed 89 patients (median age 4 years, range 6 days to 25 years), undergoing BAV during 2004–2017, from a prospective registry of a tertiary university center, with a median follow-up period of 4 years. Patients were classified into two groups based on presence of immediate post procedural AVI grade more than “+1/4” as assessed by echocardiography. Kaplan Meier cumulative mortality curves for groups above vs. bellow post procedural AVI grade “+1/4” were compared with log-rank test. Cox regression model was used to assess the risk for surgical aortic valve repair (SAVR) in long-term follow up with patients without worsening of AVI after BAV serving as the reference group. Results During follow up, SAVR was performed in 20% (n=18) of patients. Patients with immediate post procedural AVI grade more than “+1/4” after BAV had significantly higher long-term risk for SAVR compared to those without AVI worsening (72% vs. 18%, log-rank p<0.001). When adjusted for other significant aortic valve repair predictors, such as bicuspid aortic valve, neonatal age, residual aortic valve peak gradient >35 mm Hg, the presence of AVI grade more than “+1/4” immediately after BAV was independently associated with 6-fold (HR=5.60, 95% CI 2.03–15.42, p=0.001) increased risk for SAVR. Kaplan-Meier freedom from SAVR curves Conclusion The presence of post procedural AVI grade more than “+1/4” in patients undergoing BAV for congenital aortic valve stenosis is independently associated with the increased risk for SAVR in long-term follow up.

scholarly journals Long-term outcomes of aortic valve repair in children with congenital heart disease and their predictors

2020 ◽  
Vol 25 (8) ◽  
pp. 3971
Author(s):  
Z. M. Abdurakhmanov ◽  
I. N. Yemets
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Aortic Valve Repair ◽  
Long Term Results ◽  
Composite Outcome ◽  
Valve Repair ◽  
Long Term Outcomes ◽  
The Mean

Aim. To retrospectively analyze the long-term results of primary aortic valve repair (AVR) in children.Material and methods. The study included 163 patients operated on from 2004 to 2019. The mean age was 9,58±9,3 years. The patients underwent commissurotomy, decalcification, raphe resection, Trusler technique, raphe shaving, free margin plication, leaflet replacement, leaflet extension, subcommissural annuloplasty, valve sparing aortic root replacement and neocuspidization. Primary endpoint was a composite outcome of freedom from reoperation, recurrent greater than moderate aortic regurgitation, stenosis, whereas secondary — overall survival.Results. The indications for the procedure were stenotic, regurgitant or mixed defect in 80 (49,1%), 38 (23,3%), and 45 (27,6%) patients, respectively. The 10-year survival rate was 99,4%. The mean follow-up was 3,6±1,8 years. Freedom from reoperation, recurrent moderate and greater aortic regurgitation, stenosis at 1,5 and 7 years was, 95%, 70% and 47%, respectively. In multivariate analysis, Trusler technique, leaflet extension, raphe shaving, use of patch, leaflet retraction, complexity of repair were predictors for composite outcome.Conclusion. Reconstruction of aortic valve in children is effective and safe. Avoidance of predictors may significantly improve the long-term results of aortic valve repair.

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