L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients.
OBJECTIVES
The study objective is to evaluate outcome of valve-sparing root replacement(VSRR) and its comparison to composite valve-graft conduit aortic root replacement(CVG-ARR), in a cohort of patients with aortic root aneurysm +/- valve insufficiency, without valvular stenosis. Although valve-sparing procedures are preferable in young patients, there is a lack of comparative data in comparable patients.
METHODS
The VSRR procedures were performed in 2005 patients and 218 patients underwent a CVG-ARR procedure. Exclusion criteria: aortic dissection, endocarditis and valvular-stenosis. Propensity score matching (3:1 ratio) was applied to compare VSRR (reimplantation 33% and remodelling 67%) and CVG-ARR.
RESULTS
We matched 218 CVG-ARR patients to 654 VSRR patients (median age, 56.0; median follow-up was 4 years in both, IQR 1–5 years). Early mortality was 1.1% in VSRR versus 2.3% in CVG-ARR. Survival was 95.4% (95% CI 94–97%) at 5 years in VSRR versus 85.4% (95% CI 82–92%) in CVG-ARR, p = 0.002. Freedom from reintervention at 5 years was 96.8% (95% CI 95–98%) in VSRR and 95.4% (95% CI 91–99%) in CVG-ARR, p = 0.98. Additionally, there were more thromboembolism, endocarditis and bleeding events in CVG-ARR (p = 0.02).
CONCLUSIONS
This multicentre study shows excellent results after valve-sparing root replacement in patients with ascending aortic aneurysm with or without valve insufficiency. Compared to composite valve-graft aortic root replacement, survival is better and valve-related event are fewer. Consequently, valve-sparing procedures should be considered whenever a durable repair is feasible. We advocate a valve-sparing strategy even in more complex cases when performed in experienced centers.
A 54-year-old man presented with unstable angina and stroke with right hemiplegia and aphasia due to left main coronary plus 3-vessel disease, severe stenosis of bilateral internal carotid, proximal left common carotid, and proximal left subclavian arteries. Simultaneous complete revascularization was undertaken with the use of conventional cardiopulmonary bypass and moderate hypothermia (25℃). The left internal mammary artery and two saphenous vein grafts were used for coronary artery bypass, and brain revascularization consisted of a left aorta-to-common carotid Dacron graft and bilateral carotid endarterectomy. Recovery was good.
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