Safety of Comprehensive Aortic Root and Valve Repair Surgery: A Retrospective Outcomes Research by National Evidence-Based Health Care Collaborating Agency, Korea

Abstract

Comprehensive aortic root and valve repair (CARVAR) is a recently introduced surgical technique for aortic valve disease. The National Evidence-based Health Care Collaborating Agency was offered by the ministry of Health and Welfare, Korea to perform a restrospective outcome analysis for this surgical procedure. The aims of this study were to evaluate the safety of patients who underwent CARVAR surgery and to provide a rationale for further prospective randomized study. During the period of March 2007 to November 2009, 397 patients received this procedure and enrolled in this study. Clinical events including major bleeding, endocarditis, re-operation and death were followed-up till March 2010 by medical records. During the follow-up periods, 1-year cumulative incidence of major bleeding, re-operation, endocarditis and death were 3.55, 5.65, 5.05 and 5.33%/year respectively. This study showed that the CARVAR technique is not beneficial, and is indeed even more harmful than conventional valve replacement surgery.

Aortic annulus does not dilate over time after aortic root remodeling with or without annuloplasty

“…20 The results were apparently suboptimal. 20,21 Thus, a circumferential stabilization may be superior. 7 The most common circumferential annular supports currently used are the suture annuloplasty, 7 the implantation of an expansible ring, 8 and the insertion of an internal rigid device.…”

Early results after aortic annuloplasty with a complete external Dacron band

“…In the data from Toronto, the partial band annuloplasty is used in patients undergoing aortic remodeling, so the outcome of the annuloplasty per se is unclear [11]. The data from Korea are associated with high 1-year cumulative incidences of major bleeding, reoperation, endocarditis, and death (3.55%, 5.65%, 5.05%, and 5.33% per year, respectively) [13]. These data, however, are not in patients with only an external partial annuloplasty band and cusp repair.…”

Neo-Leaflet Failure after Comprehensive Aortic Root and Valve Reconstruction

“…Concerns about the CARVAR technique are based on many factors, such as selection of the subject patients, safety issues regarding the predicted complications, and long-term durability or results [ 7 ]. Some cases of complications associated with the STJ prosthetic rings have already been reported.…”