Clinical and Echocardiographic Outcomes After Aortic Valve Repair Surgery

2019 ◽  
Vol 14 (3) ◽  
pp. 209-217 ◽  
Author(s):  
Eilon Ram ◽  
Boris Orlov ◽  
Ami Shinfeld ◽  
Alexander Kogan ◽  
Leonid Sternik ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Clinical Outcomes ◽  
Multivariable Analysis ◽  
Aortic Insufficiency ◽  
Aortic Valve Repair ◽  
Pericardial Patch ◽  
Valve Repair ◽  
Significant Independent Predictor ◽  
Autologous Pericardial Patch

Objective To assess early and late clinical outcomes in patients who underwent aortic valve repair surgery for aortic valve insufficiency, and to investigate predictors for recurrence. Methods Of 151 consecutive patients who underwent aortic valve repair surgery for varying degrees of aortic insufficiency (AI) in our department between 2004 and 2018, 60 (40%) underwent aortic root replacement, 71 (47%) aortic cusp plication, 31 (20%) subcommissural annuloplasty, 29 (19%) circular annuloplasty, and 28 (18%) autologous pericardial patch augmentation. Results One patient died in the hospital (0.7%). Mean clinical and echocardiographic follow-up was 62±43 months (range 1 to 159) and 50 ± 40 months (range 1 to 158), respectively. The overall survival rate was 99.3% at 1 year and 98% at 5 years of follow-up. Seventeen patients (11.3%) had recurrent severe AI, and all of them underwent reoperation with a mean duration to reoperation of 35 ± 39 months. Risk factors for the development of recurrent significant AI (≥3) or reoperation, by univariable analysis, were unicuspid or bicuspid aortic valve (AV) ( P = 0.018), the use of subcommissural annuloplasty ( P = 0.010), the need for cusp repair ( P = 0.001), and the use of pericardial patch augmentation ( P < 0.001). By multivariable analysis only the use of pericardial patch augmentation emerged as a significant independent predictor for the development of recurrent significant AI (≥3) or reoperation ( P = 0.020). Conclusion AV repair can be performed with low morbidity and mortality, with good early and late clinical outcomes. However, in our experience there was a significant rate of recurrent AI especially in patients who underwent cusp augmentation using glutaraldehyde-treated autologous pericardial patch.

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.

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 Aortic Valve Repair Using a Glutaraldehyde-treated Autologous Pericardial Patch in Children with Aortic Valve Disease

2015 ◽  
Vol 31 (6) ◽  
pp. 329-337
Author(s):  
Kenta Imai ◽  
Keiichi Fujiwara ◽  
Kosuke Yoshizawa ◽  
Mamoru Hamuro ◽  
Nobuhisa Ohno ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Disease ◽  
Valve Disease ◽  
Aortic Valve Repair ◽  
Pericardial Patch ◽  
Valve Repair ◽  
Autologous Pericardial Patch

scholarly journals Aortic valve repair with autologous pericardial patch☆

2006 ◽  
Vol 30 (2) ◽  
pp. 244-249 ◽  
Author(s):  
H LAUSBERG ◽  
D AICHER ◽  
F LANGER ◽  
H SCHAFERS
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Repair ◽  
Pericardial Patch ◽  
Valve Repair ◽  
Autologous Pericardial Patch

Quadricuspid Aortic Valve Repair Facilitated by Geometric Ring Annuloplasty

2021 ◽  
pp. 155698452110030
Author(s):  
Joseph A. McGuire ◽  
Heather K. Hayanga ◽  
Jeremiah W. Hayanga ◽  
Daniel Sloyer ◽  
Matthew Ellison ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Patient Outcomes ◽  
Systematic Approach ◽  
Aortic Insufficiency ◽  
Aortic Valve Repair ◽  
Autologous Reconstruction ◽  
Quadricuspid Aortic Valve ◽  
Valve Repair ◽  
Ring Annuloplasty ◽  
Annular Geometry

Quadricuspid aortic valve (QAV) is a rare congenital anomaly often associated with aortic insufficiency. The exact anatomy of QAV is variable, and most cases have undergone aortic valve replacement. With the recognition that aortic valve repair achieves superior patient outcomes as compared to replacement, a systematic approach to autologous reconstruction of QAV is needed. This article reports 2 cases having successful repair utilizing geometric aortic annuloplasty rings, and describes a proposed scheme for repairing most QAV defects, based on relative leaflet and commissural characteristics. Using either tri-leaflet or bicuspid ring annuloplasty, the normal sub-commissural triangles can be remodeled into a 120° or 180° configuration, respectively, and then the leaflets can be sutured and plicated to fit annular geometry. With this approach, most quadricuspid valves potentially could undergo autologous reconstruction.

scholarly journals Comparison of bicuspid and tricuspid aortic valve repair

2020 ◽  
Author(s):  
Radosław Gocoł ◽  
Jarosław Bis ◽  
Marcin Malinowski ◽  
Joanna Ciosek ◽  
Damian Hudziak ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Hazard Ratio ◽  
Aortic Valve Repair ◽  
Pericardial Patch ◽  
Valve Regurgitation ◽  
Aortic Valve Regurgitation ◽  
Valve Repair ◽  
Tricuspid Aortic Valve ◽  
Valve Annulus ◽  
Annulus Diameter

Abstract   OBJECTIVES The aim of this study was to compare the outcomes of tricuspid aortic valve (TAV) and bicuspid aortic valve (BAV) repair. METHODS We assessed mortality, freedom from reoperation and the rate of aortic valve regurgitation recurrence. Mortality in both groups was compared with expected survival, and risk factors for reoperation were identified. RESULTS From January 2010 to April 2020, a total of 368 elective aortic valve repair procedures were performed, including 223 (60.6%) in patients with TAV. The perioperative mortality was 0.7% in the BAV group and 3.6% in the TAV group (P = 0.079). Estimated survival at 5 years in the BAV versus TAV group was 97 ± 3% vs 80 ± 6%, respectively (P &lt; 0.001). Freedom from reoperation at 5 years in the TAV versus BAV group was 96 ± 3% vs 93 ± 4%, respectively (P = 0.28). Grade 2 or more aortic valve regurgitation was noted in 9.9% of BAV patients and 11% of TAV patients (P = 0.66). Reoperation was predicted by cusp perforation [hazard ratio 15.86 (4.44–56.61); P &lt; 0.001], the use of pericardial patch [hazard ratio 8.58 (1.96–37.53); P = 0.004] and aortic valve annulus diameter &gt;27.5 mm [hazard ratio 3.07 (0.99–9.58); P = 0.053]. CONCLUSIONS BAV repair is as durable as TAV repair. BAV is not a predictor of a higher rate of reoperations. BAV repair yields survival comparable to expected. Cusp perforation, aortic valve annulus diameter &gt;27.5 mm and the use of pericardial patch adversely impact long-term outcome of aortic valve repair.

scholarly journals Midterm follow-up dynamic echocardiography evaluation after aortic valve repair for aortic valve insufficiency

2012 ◽  
Vol 14 (6) ◽  
pp. 721-724 ◽  
Author(s):  
G. D'Ancona ◽  
A. Amaducci ◽  
J. Prodromo ◽  
F. Pirone ◽  
M. Follis ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Repair ◽  
Aortic Valve Insufficiency ◽  
Valve Repair ◽  
Valve Insufficiency

Ascending Aortic Replacement With Aortic Valve Reimplantation

Circulation ◽  
1999 ◽  
Vol 100 (suppl_2) ◽  
Author(s):  
Wolfgang Harringer ◽  
Klaus Pethig ◽  
Christian Hagl ◽  
Gerd P. Meyer ◽  
Axel Haverich
Keyword(s):  
Aortic Valve ◽  
Aortic Insufficiency ◽  
Additional Patient ◽  
Valve Repair ◽  
Sinotubular Junction ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement ◽  
Ischemic Attack ◽  
Aortic Valve Reimplantation

Background —Reimplantation of the native, structurally intact aortic valve within a Dacron tube graft in patients with aortic root aneurysms corrects annular ectasia and dilatation of the sinotubular junction. The durability of this valve repair with respect to the increased mechanical stress on valve cusps has been discussed, is quite controversial, and is yet unknown. Methods and Results —From July 1993 to November 1998, a replacement of the ascending aorta with a repair of the aortic valve was performed in 75 patients (53 men and 22 women aged 50±19 years). Twenty-one patients (28%) had Marfan syndrome, and 11 patients (15%) had an aortic dissection, type Stanford A (6 acute, 5 chronic). In 17 patients (23%), concomitant replacement of the aortic arch was necessary. Clinical and echocardiographic follow-up was performed in 6- to 12-month intervals for a cumulative study period of 137 patient-years. No operative deaths occurred. Two patients (3%) died 5 and 20 months postoperatively. One additional patient experienced a transient ischemic attack within the first postoperative week. Three patients (4%) with progressive aortic insufficiency required aortic valve replacement after 9, 11, and 14 months. All other patients had no or mild aortic insufficiency. The repairs have now remained stable for ≤65 months (mean, 22±20 months). Other valve-related complications did not occur. Conclusions —Our results demonstrate that this type of aortic valve repair achieves excellent results in selected patients. Perfect coaptation of valve cusps during the repair with no or only trace aortic insufficiency at initial echocardiography seems to be essential for durability.

scholarly journals Predictors of Recurrent Aortic Insufficiency in Type I Bicuspid Aortic Valve Repair

2018 ◽  
Vol 106 (5) ◽  
pp. 1316-1324 ◽  
Author(s):  
Andreas Habertheuer ◽  
Rita Karianna Milewski ◽  
Joseph E. Bavaria ◽  
Mary Siki ◽  
Melanie Freas ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Aortic Insufficiency ◽  
Aortic Valve Repair ◽  
Type I ◽  
Valve Repair

Intraoperative diagnosis of a quadricuspid aortic valve

2017 ◽  
Vol 26 (9) ◽  
pp. 704-706
Author(s):  
Hassan Tatari ◽  
Maziar Gholampour Dehaki ◽  
Gholamreza Omrani ◽  
Hafez Ghaheri ◽  
Alwaleed Al-Dairy ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Regurgitation ◽  
Septal Defect ◽  
Incidental Finding ◽  
Aortic Valve Repair ◽  
Quadricuspid Aortic Valve ◽  
Valve Regurgitation ◽  
Valve Repair ◽  
Ventricular Septal Defect Closure

Quadricuspid aortic valve is a rare anomaly, and most patients require surgery for aortic regurgitation in the 5th or 6th decades of life; only a few cases of aortic valve repair in childhood have been reported. A 3-year-old boy was scheduled for ventricular septal defect closure and aortic valve repair. Quadricuspid aortic valve was an incidental finding at operation; it was repaired by joining the left anterior and right anterior cusps. At the 9-month follow-up, the patient had no more than mild aortic regurgitation. We emphasize the importance of detecting this anomaly, especially in children with aortic valve regurgitation.

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