Surgical Treatment of Aortic Regurgitation due to Takayasu Arteritis

Abstract

Background— The goal of this retrospective study was to determine the late outcome of surgical treatment for aortic valve regurgitation due to Takayasu arteritis and correlate it with evidence of inflammation on pathological examination. Methods and Results— Ninety consecutive patients who underwent surgery for aortic valve regurgitation due to Takayasu arteritis between 1979 and 2003 were studied. Intraoperative pathological specimens of the aortic wall from 69 patients were retrospectively examined for inflammation. Aortic valve replacement was performed in 63 patients (group A) and composite graft repair in 27 patients (group B). The aortic root diameter was 39.9±9.5 mm in group A and 54.4±13.6 mm in group B ( P <0.0001). Preoperative steroid therapy was performed in 40 patients (44.4%). Hospital mortality was 4.8% (3/63) in group A and 7.4% (2/27) in group B. The overall 15-year survival rate was 76.1%. Detachment of the valve or graft occurred in 11.1% (7/63) of group A and in 3.7% (1/27) of group B patients ( P =0.43). Late dilatation (>50 mm) of the residual ascending aorta occurred in 11.1% (7/63) of group A and in 3.7% (1/27) of group B patients ( P =0.43). Active inflammation was confirmed in intraoperative pathological specimens of 10 patients, and detachment of the valve or graft occurred in 4 of these patients. Univariate analysis of background variables revealed active inflammation to be a risk factor for detachment ( P =0.0001; risk ratio 55). Conclusions— Late dilatation of the ascending aorta after aortic valve replacement is a clinically important finding. Active inflammation could be related to valve or graft detachment.

Aortic regurgitation and aortic valve operation in Takayasu arteritis: A meta-analysis

“…One article (2.4%) was an original article, [10] two (4.9%) were case series, [26,42] The presenting symptoms were available for 32 patients with 63 manifestations. The major manifestations were circulatory (41.3%), followed by constitutional (25.4%), pains (17.5%), neurological (9.5%) and local symptoms (4.8%).…”

“…[12,14,15,20,23,24,28,[30][31][32]47] The degree of AR was not reported in 118 patients (74.2%). [10,16,18,22,26,35,38,45,50] In the remaining 41 patients (25.8%), one (2.4%) was mild, [29] nine (22.0%) were moderate, [11,12,23,34,37,41,42,49] one (2.4%) was moderate-to-severe [37] and 30 (73.2%) were severe [13][14][15]17,[19][20][21]24,25,27,28,[30][31][32][33]36,39,40,[42][43][44]…”

“…[10][11][12]14,15,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][38][39][40]42,[44][45][46][47][48][49][50] The aortic valve operations that were performed in these patients were: aortic valve repair in three (2%) [12,30,32] (in one of them, aortic valve repair was performed after a three-week steroid treatment), [32] aortic valve replacement in 98 (65.3%), [10,11,14,17,18,20,[22][23][24][25]...…”

“…[50] The timing of complication development was at 66.0±70.1 months (range 0.5-204 months; median 36 months) (n=16) postoperatively. Reintervention for complications was warranted in 13 patients (41.9%), [10,[21][22][23]35,36,38,42,44,47] but Yuan. Aortic regurgitation in Takayasu arteritis one patient refused.…”

“…[9] Active inflammation has been proved to be a predictive risk factor of these lethal complications. [10] Therefore, a cardiac operation in TA patients at an active inflammation stage seems to be risky. [9] AR and aortic valve operation in TA have not been sufficiently elucidated in terms of the clinical features, treatment of choices and prognosis.…”