Valve Cuspidity: A Risk Factor for Aortic Valve Repair?

Holubec, Tomáš; Žáček, Pavel; Jamaliramin, Mostafa; Emmert, Maxmilian Y.; Tuna, Martin; Nedbal, Pavel; Dominik, Jan; Harrer, Jan; Falk, Volkmar; Vojacek, Jan

doi:10.1111/jocs.12382

Cited by 12 publications

(16 citation statements)

References 25 publications

(85 reference statements)

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“…Beside the known low procedural risk and good clinical outcomes [ 1 – 8 , 10 , 13 , 14 ], the expectation of a superior quality of postoperative life might play a role in decision for aortic valve-sparing strategy. Hypothetically, better quality of life should result from the absence of anticoagulation and related life-style limitations, awareness of permanent risk of thromboembolic and bleeding complications, absence of blood checking and vigilance against prosthetic infection [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Quality of life after aortic valve repair is similar to Ross patients and superior to mechanical valve replacement: a cross-sectional study

Žáček

Holubec

Vobornik

et al. 2016

BMC Cardiovasc Disord

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BackgroundIn patients after aortic valve surgery, the quality of life is hypothesized to be influenced by the type of the valve procedure. A cross-sectional study on the postoperative quality of life was carried out in patients after aortic valve-sparing surgery (with regards to the age of the patient), Ross procedure and mechanical aortic valve replacement.MethodsQuality of life was studied in 139 patients after aortic valve surgery divided into four study groups (Y – aortic valve-sparing procedure at the age below 50 years, mean age 36.2 years; O – aortic valve-sparing procedure at the age 50 years and over, mean age 59.2 years; R – Ross procedure, mean age 37.8 years and M – mechanical aortic valve replacement at the age below 50 years, mean age 39.2 years). SF-36 Short Form and valve-specific questionnaires were mailed to the patients after 6 months or later following surgery (median 26.9 months).ResultsIn SF-36, the younger aortic valve repair patients and the Ross patients scored significantly better in 4 of 4 physical subscales and in 2 of 4 mental subscales than the older aortic valve repair and mechanical valve replacement patients. In the valve-specific questionnaire; however, all 3 groups free of anticoagulation (Y, O, and R) displayed greater freedom from negative valve-related concerns.ConclusionsPostoperative quality of life is influenced by the type of aortic valve procedure and is negatively linked with mechanical prosthesis implantation and long-term anticoagulation. Aortic valve-sparing strategy should be considered in cases with suitable valve morphology due to favorable clinical results and beneficial impact on the long-term quality of life.

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Section: Discussionmentioning

confidence: 99%

Quality of life after aortic valve repair is similar to Ross patients and superior to mechanical valve replacement: a cross-sectional study

Žáček

Holubec

Vobornik

et al. 2016

BMC Cardiovasc Disord

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“…The mean patient age ranged from 41 to 64 years, with an overall patient mean age of 45.3 years across all included studies. Within individual studies, however, age was more varied, with one study including patients ranging from 3 to 86 years15 and others including patients between 20 and 68 years of age 2021 The proportion of patients with aortic regurgitation was between 70% and 100% in all studies except for one 23.…”

Section: Resultsmentioning

confidence: 99%

“…This suggests a considerably lower early mortality rate compared to a previous meta-analysis which did not focus exclusively on patients with BAVD (pooled estimated early mortality 0.026, 95% CI 0.014 to 0.044),6 potentially highlighting differences and the need for differentiations of patients with bicuspid versus tricuspid valves. However, two studies found no difference in long-term survival between the two valve types,20 22 although this might have been due to the rare occurrence of late deaths after the procedure. Our results confirm and extend the findings of another systematic review of 30, often small, aortic valve repair studies in BAVD patients which found a median 30-day mortality rate of 0% 7…”

Section: Discussionmentioning

confidence: 97%

Bicuspid aortic valve disease: systematic review and meta-analysis of surgical aortic valve repair

et al. 2016

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Aortic valve repair is still emerging, and its role in the treatment of bicuspid aortic valve disease (BAVD) is not yet fully understood. Our objective is to synthesise available evidence on outcomes after surgical aortic valve repair in patients with BAVD. We conducted a systematic review of clinical studies using prespecified methods for searching, identifying and selecting eligible studies in 4 databases, and synthesising results (PROSPERO 2014:CRD42014014415). 2 researchers independently reviewed full-text articles and extracted data. The results of included studies were quantitatively synthesised in frequentist meta-analyses. We included 11 aortic valve repair studies or study arms with a total of 2010 participants. Pooled estimates for the proportion of patients surviving at 30 days, 1 year, 5 years and 10 years were 0.995 (95% CI 0.991 to 0.995), 0.994 (0.989 to 0.999), 0.945 (0.898 to 0.993) and 0.912 (0.845 to 0.979), respectively. The pooled proportion of late deaths from valve-related causes was 0.008 (0.000 to 0.019) at a mean follow-up of 3.5 years. Proportion of patients with valve-related reinterventions was 0.075 (0.037 to 0.113) at a mean follow-up of 3.9 years, and the linearised reintervention rate was 1.3 (0.7 to 1.9) per 100 patient-years. Outcome reporting was insufficient to pool the results for a number of predefined outcomes. In conclusion, existing evidence on aortic valve repair in BAVD is limited to mostly small case series, case–control and small retrospective cohort studies. Despite the low quality, available evidence suggests favourable survival outcomes after aortic valve repair in selected patients with BAVD. Valve-related reinterventions at follow-up are common in all patients undergoing repair surgery.

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“…The surgical technique has been previously described by our group [14]. Briefly, the geometric and effective height of the leaflets, presence of cusp prolapse, and the presence and location of degenerative changes, calcifications, and cusp fenestrations were analyzed in every valve.…”

Section: Surgical Techniquementioning

confidence: 99%

“…Since Lansac and colleagues [12] introduced in 2005 the external aortic annuloplasty ring, the aortic root remodeling combined with the implantation of expansible annuloplasty ring evolved in the standardized physiologic approach to the valve-sparing root replacement [7]. This approach was adopted at our department in 2010 and has become the procedure of choice in patients with AR and root aneurysm [14]. Values are expressed as mean AE SD unless otherwise indicated.…”

Section: Commentmentioning

confidence: 99%

An Expansible Aortic Ring in Aortic Root Remodeling: Exact Position, Pulsatility, Effectiveness, and Stability in Three-Dimensional CT Study

Holubec

Higashigaito

Bëlobrádek

et al. 2017

The Annals of Thoracic Surgery

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Valve Cuspidity: A Risk Factor for Aortic Valve Repair?

Abstract: This study demonstrates no difference in mid-term results after regurgitant bicuspid and tricuspid aortic valve repair, suggesting that bicuspid valve may not be a risk factor for aortic valve repair.

Cited by 12 publications

References 25 publications

Quality of life after aortic valve repair is similar to Ross patients and superior to mechanical valve replacement: a cross-sectional study

Quality of life after aortic valve repair is similar to Ross patients and superior to mechanical valve replacement: a cross-sectional study

Bicuspid aortic valve disease: systematic review and meta-analysis of surgical aortic valve repair

An Expansible Aortic Ring in Aortic Root Remodeling: Exact Position, Pulsatility, Effectiveness, and Stability in Three-Dimensional CT Study

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