Expanding relevance of aortic valve repair-is earlier operation indicated? J Thorac Cardiovasc Surg 2014 Jan;147(1):100-7
Date
10/03/2013Pubmed ID
24084289DOI
10.1016/j.jtcvs.2013.08.015Scopus ID
2-s2.0-84890553030 (requires institutional sign-in at Scopus site) 39 CitationsAbstract
OBJECTIVES: To define the durability of aortic valve repair (AVRep) and the effect of surgical timing on late survival.
METHODS: From June 1986 to June 2011, 331 patients underwent elective AVRep for aortic regurgitation (mean age, 53 ± 17 years; 76% men). The repair methods included commissuroplasty (n = 270; 81%), triangular resection and plication (n = 106; 32%), resuspension or cusp shortening (n = 102; 31%), and perforation closure (n = 23; 7%).
RESULTS: In-hospital mortality was 0.6% (2 of 332). Four patients (1%) experienced early repair failure; two underwent repeat repair. Overall survival was 91% and 81% at 5 and 10 years, respectively. After adjusting for age, greater left ventricular end-systolic dimension (per 5 mm; hazard ratio [HR], 1.49; 95% confidence interval [CI], 1.23-1.79; P < .001) and lower ejection fraction (per 5%; HR, 1.42; 95% CI, 1.25-1.63; P ≤ .001) were significant predictors of long-term mortality. Patients with ejection fraction < 50% and left ventricular end-systolic dimension > 50 mm had significantly greater odds of late death (HR, 3.46; 95% CI, 2.05-5.82; P < .001 and HR, 2.08; 95% CI, 1.05-4.12; P = .036, respectively). The risk of aortic valve reoperation was 10% and 21% at 5 and 10 years, respectively. The presence of severe aortic regurgitation (HR, 2.2; 95% CI, 1.1-5.06; P = .02) and more than mild regurgitation at discharge (HR, 5.87; 95% CI, 2.67-12.68; P ≤ .0001) were predictors of late reoperation. Freedom from other valve-related events was 94% and 91% at 5 and 10 years, respectively. Forty-seven patients (21%) with intact valve repair were using warfarin at the last follow-up visit.
CONCLUSIONS: AVRep can be performed with excellent late survival and freedom from valve-related events. Awaiting the onset of ventricular dysfunction increases the risk of late mortality, warranting earlier consideration of AVRep for patients with suitable anatomy.
Author List
Sharma V, Suri RM, Dearani JA, Burkhart HM, Park SJ, Joyce LD, Li Z, Schaff HVMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Aged, 80 and over
Anticoagulants
Aortic Valve
Aortic Valve Insufficiency
Cardiac Surgical Procedures
Cardiac Valve Annuloplasty
Female
Hospital Mortality
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Patient Selection
Postoperative Complications
Proportional Hazards Models
Reoperation
Retrospective Studies
Risk Factors
Severity of Illness Index
Stroke Volume
Time Factors
Time-to-Treatment
Treatment Outcome
Ventricular Function, Left
Warfarin
Young Adult
