The fate of mild to moderate proximal aortic dilatation after isolated aortic valve replacement in tricuspid aortic valve patients

Abstract OBJECTIVES Elective treatment of aortic valve disease by transcatheter aortic valve replacement (TAVR) is becoming increasingly popular, even in patients with low risk and intermediate risk. Even patients with a bicuspid aortic valve (BAV) are increasingly considered eligible for TAVR. Permanent pacemaker implantation (PMI) is a known—frequently understated—complication of TAVR affecting 9–15% of TAVR patients with a potentially significant impact on longevity and quality of life. BAV patients are affected by the highest PMI rates, although they are frequently younger compared to their tricuspid peers. The aim of the study is to report benchmark data—from a high-volume centre (with a competitive TAVR programme) on PMI after isolated surgical aortic valve replacement (SAVR) in patients with BAV and tricuspid aortic valve (TAV). METHODS We performed a retrospective single-centre analysis on 4154 patients receiving isolated SAVRs (w/o concomitant procedures), between 2000 and 2019, of whom 1108 had BAV (27%). PMI rate and early- and long-term outcomes were analysed. For better comparability of these demographically unequal cohorts, 1:1 nearest neighbour matching was performed. RESULTS At the time of SAVR, BAV patients were on average 10 years younger than their TAV peers (59.7 ± 12 vs 69.3 ± 9; P < 0.001) and had less comorbidities; all relevant characteristics were equally balanced after statistical matching. Overall PMI rate was significantly higher in BAV patients (5.4% vs 3.8%; P = 0.03). BAV required PMI exclusively (100%) and TAV required predominately (96%) for persistent postoperative high-degree atrioventricular block. After matching, the PMI rate was similar (5.1% vs 4.4%, P = 0.5). In-hospital mortality in the matched cohort was 1% in both groups. Long-term survival was more favourable in BAV patients (94% vs 90% in TAV at 5 years; 89% vs 82% in TAV at 9 years; P = 0.013). CONCLUSIONS With SAVR, the overall incidence of PMI among BAV patients seems significantly higher; however, after propensity matching, no difference in PMI rates between BAV and TAV is evident. The PMI rate was remarkably lower among BAV patients after SAVR compared to the reported incidence after TAVR.

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Failure to Prevent Progressive Dilation of Ascending Aorta by Aortic Valve Replacement in Patients With Bicuspid Aortic Valve: Comparison With Tricuspid Aortic Valve

Circulation ◽

10.1161/01.cir.0000087449.03964.fb ◽

2003 ◽

Vol 108 (90101) ◽

pp. 291II--294 ◽

Cited By ~ 77

Author(s):

H. Yasuda

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Bicuspid Aortic Valve ◽

Ascending Aorta ◽

Tricuspid Aortic Valve

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Late Aortic Dissection after Aortic Valve Replacement for Aortic Regurgitation with Slight Aortic Dilatation Successfully Repaired by the Bentall Procedure.

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.23.355 ◽

1994 ◽

Vol 23 (5) ◽

pp. 355-359 ◽

Cited By ~ 1

Author(s):

Shunji Uchita ◽

Sunao Watanabe ◽

Kazuhide Hayashi ◽

Hideki Yamanishi

Keyword(s):

Aortic Valve ◽

Aortic Dissection ◽

Aortic Valve Replacement ◽

Aortic Regurgitation ◽

Valve Replacement ◽

Aortic Dilatation ◽

Bentall Procedure

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Prospects of development in aortic surgery: literature review

Perm Medical Journal ◽

10.17816/pmj37543-51 ◽

2021 ◽

Vol 37 (5) ◽

pp. 43-51

Author(s):

B. K. Kadyraliev ◽

V. B. Arutyunyan ◽

M. N. Askadinov ◽

S. V. Kucherenko

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Malignant Tumors ◽

Chronic Renal Disease ◽

Aortic Surgery ◽

Aortic Ring ◽

Good Alternative ◽

Aortic Dilatation ◽

Repeated Surgery

Foreign sources of literature regarding the issue of aortic surgery are analyzed. Special attention is paid to aortic valve replacement using the Ozaki technique. The first replacement of aortic valve cusps with synthetic material was implemented by H. Th. Bahnson in 1959; he implanted the neocusp from Teflon. Nowadays, so as to replace the aortic valve, mechanical, biological valves, homotransplants, autotransplants and valves imitated endovascularly are actively applied. All the above mentioned types of the valves have both merits and demerits, therefore each patient should have an individual approach. When choosing the prosthesis and type of surgical intervention, cardiosurgeons take into account the following factors: patients age, availability of concomitant diseases (atrial fibrillation, chronic renal disease, malignant tumors), presence of small aortic ring, aortic dilatation, availability of other valve diseases, infectious endocarditis, first or repeated surgery on the valve as well as pregnancy or planning of pregnancy. In 2007, Shigeyuki Ozaki proposed the technique for replacement of all aortic valve cusps from autopericardium treated with 0.6 % glutaraldehyde solution. This surgery permits to form the aortic valve with excellent hemodynamic characteristics and low rate of reoperation in the early and remote periods. Aortic valve replacement using Ozaki technique is a perspective technique and good alternative for surgical treatment of aortic valve along with prostheses.

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