Efficacy of Aortic Valve Resuspension in Establishing Valve Competence in Acute Type A Dissections

Tang, Paul C.; Badami, Abbasali; Akhter, Shahab A.; Osaki, Satoru; Lozonschi, Lucian; Kohmoto, Takushi; Oliveira, Nilto C. De

doi:10.1016/j.athoracsur.2016.08.099

Cited by 18 publications

(15 citation statements)

References 17 publications

(36 reference statements)

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“…Although previous reports demonstrated preoperative severe AR as a risk factor for progressive AR, 16,17 it has not been reported exactly how the postoperative residual regurgitation changes during follow-up. Our results showed that the risk of significant AR increases when postoperative regurgitation remains.…”

Section: Discussionmentioning

confidence: 94%

The fate of residual aortic regurgitation after ascending aorta replacement in type A aortic dissection

Kim

Lee

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

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Objective: This study aimed to evaluate the changes in postoperative aortic regurgitation (AR) and determine the predictors of significant AR and root reoperation after ascending aortic replacement (AAR) in patients with acute type A aortic dissection.Methods: From January 1995 to December 2017, 271 consecutive patients underwent valve/root-preserving AAR (n ¼ 225) and root replacement (n ¼ 46). AR grade trend over time was analyzed by the ordinal mixed-effects model. Significant AR was defined as AR grade !3þ during the follow-up period. Predischarge and follow-up echocardiograms were obtained in 95.6% and 88.8% of enrolled patients, respectively.Results: At predischarge, postoperative !2þ AR was present in 20 (9.3%) and 1 (2.3%) patients in the AAR and root replacement groups, respectively. With increasing time after surgery, the grade of AR increased. At 10 years, 4.6% of patients had developed 3þ or 4þ AR. Considering death as the competing risk, the 10-year cumulative incidence of significant AR was significantly higher in the AAR than in the root replacement group (12.3% vs 2.2%; P ¼ .047). The risk of root reoperation at 10 years was not different between the groups (P ¼ .118). On Cox analysis, preoperative !3þ AR (P ¼ .002), postoperative !2þ AR (P ¼ .040), and false to true lumen ratio (P ¼ .005) were associated predictors of significant AR.Conclusions: Although valve/root-preserving AAR demonstrated reasonable longterm outcomes when compared with root replacement, preoperative !3þ AR, postoperative !2þ AR, and high false to true lumen ratio significantly increased the risk of significant AR. Therefore, careful echocardiographic surveillance may be warranted in patients with postoperative !2þ AR and small true lumen.

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Section: Discussionmentioning

confidence: 94%

The fate of residual aortic regurgitation after ascending aorta replacement in type A aortic dissection

Kim

Lee

et al. 2020

The Journal of Thoracic and Cardiovascular Surgery

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“…In emergency situation, aortic valve replacement could be performed to AD patients (Erbel et al, 2014a,b). Aortic valve resuspension with supra-coronary aortic replacement could be recommended to restore aortic valve competency in most AD patients with acceptable mid-term survival (Tang et al, 2017).…”

Section: Aortic Aneurysm and Dissection: Need More Predictors And Timmentioning

confidence: 99%

Bicuspid Aortic Valve: An Update in Morphology, Genetics, Biomarker, Complications, Imaging Diagnosis and Treatment

Liu

Xie

et al. 2019

Front. Physiol.

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The bicuspid aortic valve, a kind of heart disease that comes from parents, has been paid attention around the world. Although most bicuspid aortic valve (BAV) patients will suffer from some complications including aortic stenosis, aortic regurgitation, endocarditis, and heart dysfunction in the late stage of the disease, there is none symptom in the childhood, which restrains us to diagnose and treatment in the onset phase of BAV. Hemodynamic abnormalities induced by the malformations of the valves in BAV patients for a long time will cause BAV-associated aortopathy: including progress aortic dilation, aneurysm, dissection and rupture, cardiac cyst and even sudden death. At present, preventive surgical intervention is the only effective method used in this situation and the diameter of the aorta is the primary reference criterion for surgery. And the treatment effects are always not satisfactory for patients and clinicians. Therefore, we need more methods to evaluate the progression of BAV and the surgery value and the appropriate intervention time by combining basic research with clinical treatment. In this review, advances in morphology, genetic, biomarkers, diagnosis and treatments are summarized, which expects to provide an update about BAV. It is our supreme expectations to provide some evidences for BAV early screening and diagnosis, and in our opinion, personalized surgical strategy is the trend of future BAV treatment.

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“…Furthermore, aortic root replacement during the repair of an acute aortic dissection has been reported by some 4 to increase operative mortality, although this is contested in other reports. 5,6…”

Section: Introductionmentioning

confidence: 99%

Likelihood of Aortic Valve Preservation During Repair of Acute Type A Aortic Dissection

Thornhill

Shih

Amen

et al. 2020

The American Surgeon™

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Background We sought risk factors for replacement of the aortic valve with or without the root (AVR/root) in the setting of acute type A aortic dissection (ATAD) repair. Methods All ATAD repairs at our institution from January 2005 to June 2018 were reviewed. Baseline characteristics were recorded. For patients with aortic valve preservation, we documented the degree of aortic insufficiency (AI) postoperatively and on subsequent echocardiograms when available. Logistic regression was used to determine the association between preoperative characteristics and the odds ratio of AVR/root. Results 206 patients underwent repair of ATAD. Thirty-four were excluded for no documented AI grading. Forty-six underwent AVR/root during repair of the ATAD (including 40 root replacements). Of 126 that did not undergo AVR/root, 42 (33.33%) had follow-up echocardiograms at a median of 68 months postoperatively, 2 required reintervention for valve insufficiency. An increase in the degree of AI, bicuspid valve morphology, size of the aortic root, and connective tissue disorder was significantly associated with increased risk of AVR/root. Of 130 patients without connective tissue disorder, bicuspid aortic valve, aortic root aneurysm or intimal root tear, the rate of valve preservation was 65/65 (100%), 25/29 (86.2%), and 22/40 (55%) for those presenting with mild, moderate, and severe AI, respectively. Conclusion The degree of preoperative AI, bicuspid valve morphology, size of the aortic root, and connective tissue disorder significantly correlate with the failure of aortic valve preservation in patients with ATAD. The vast majority of tricuspid valves in patients without connective tissue disorder or aortic root pathology can be salvaged.

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Efficacy of Aortic Valve Resuspension in Establishing Valve Competence in Acute Type A Dissections

Abstract: AV resuspension is able to improve valve competency with good outcomes even in patients with moderate or severe AI at presentation. Overall long-term survival is unchanged compared with other operative strategies for the AV.

Cited by 18 publications

References 17 publications

The fate of residual aortic regurgitation after ascending aorta replacement in type A aortic dissection

The fate of residual aortic regurgitation after ascending aorta replacement in type A aortic dissection

Bicuspid Aortic Valve: An Update in Morphology, Genetics, Biomarker, Complications, Imaging Diagnosis and Treatment

Likelihood of Aortic Valve Preservation During Repair of Acute Type A Aortic Dissection

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