TY - JOUR
T1 - Long-term durability of bicuspid aortic valve repair
AU - Svensson, Lars G.
AU - Al Kindi, Adil H.
AU - Vivacqua, Alessandro
AU - Pettersson, Gösta B.
AU - Gillinov, A. Marc
AU - Mihaljevic, Tomislav
AU - Roselli, Eric E.
AU - Sabik, Joseph F.
AU - Griffin, Brian
AU - Hammer, Donald F.
AU - Rodriguez, Leonardo
AU - Williams, Sarah J.
AU - Blackstone, Eugene H.
AU - Lytle, Bruce W.
N1 - Funding Information:
This study was supported in part by the following: The Peter and Elizabeth C. Tower and Family Endowed Chair in Cardiothoracic Research, James and Sharon Kennedy, the Slosburg Family Charitable Trust, Stephen and Saundra Spencer, and Martin Nielsen (G.B.P.); The Judith Dion Pyle Endowed Chair in Heart Valve Research (A.M.G.); The Donna and Ken Lewis Chair in Cardiothoracic Surgery and the Peter Boyle Research Fund (T.M.); The Sheikh Hamdan bin Rashid Al Maktoum Distinguished Chair in Thoracic and Cardiovascular Surgery (J.F.S.); The John and Rosemary Brown Endowed Chair in Cardiovascular Medicine (B.G.); and The Kenneth Gee and Paula Shaw, PhD, Chair in Heart Research (E.H.B.).
PY - 2014/5
Y1 - 2014/5
N2 - Background Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, occurring in 1% to 2% of the population. Eventually, 20% develop clinically important valvar regurgitation requiring surgical intervention. Aortic valve repair avoids anticoagulation and prosthetic valve-related complications. This study evaluated long-term durability of BAV repair. Methods From 1985 to 2011, 728 patients, mean age 42 ± 12 years, underwent BAV repair at Cleveland Clinic. Mean follow-up was 9.0 ± 6.2 years (median, 8.3). Factors associated with repair durability (expressed as aortic valve reoperations and echocardiographically estimated gradients and regurgitation) and survival were identified. Results Hospital mortality was 0.41% (n = 3), and stroke occurred in 0.27% (n = 2). Freedom from aortic valve reoperation at 10 years was 78%. Risk of reoperation was highest immediately after operation and fell rapidly to approximately 2.6%/year up to 15 years. Primary reasons for reoperation were cusp prolapse (38%), aortic stenosis or regurgitation (17%), and aortic regurgitation from root aneurysm (15%). Aortic valve gradients showed an early initial peak, rapidly declined, then rose steadily, accompanied by an increase in left ventricular mass. Survival was 94% at 10 years. A risk factor for early death was greater preoperative mitral valve regurgitation, and for late death, older age at operation, more severe symptoms, and poorer left ventricular function. Conclusions BAV repair is safe and durable with low mortality, low prevalence of reoperation, and good long-term survival. Cusp prolapse from technical errors and natural progression of disease are the most common causes for reoperation, but progressive natural increase in valve gradient accounts for a substantial proportion as well.
AB - Background Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, occurring in 1% to 2% of the population. Eventually, 20% develop clinically important valvar regurgitation requiring surgical intervention. Aortic valve repair avoids anticoagulation and prosthetic valve-related complications. This study evaluated long-term durability of BAV repair. Methods From 1985 to 2011, 728 patients, mean age 42 ± 12 years, underwent BAV repair at Cleveland Clinic. Mean follow-up was 9.0 ± 6.2 years (median, 8.3). Factors associated with repair durability (expressed as aortic valve reoperations and echocardiographically estimated gradients and regurgitation) and survival were identified. Results Hospital mortality was 0.41% (n = 3), and stroke occurred in 0.27% (n = 2). Freedom from aortic valve reoperation at 10 years was 78%. Risk of reoperation was highest immediately after operation and fell rapidly to approximately 2.6%/year up to 15 years. Primary reasons for reoperation were cusp prolapse (38%), aortic stenosis or regurgitation (17%), and aortic regurgitation from root aneurysm (15%). Aortic valve gradients showed an early initial peak, rapidly declined, then rose steadily, accompanied by an increase in left ventricular mass. Survival was 94% at 10 years. A risk factor for early death was greater preoperative mitral valve regurgitation, and for late death, older age at operation, more severe symptoms, and poorer left ventricular function. Conclusions BAV repair is safe and durable with low mortality, low prevalence of reoperation, and good long-term survival. Cusp prolapse from technical errors and natural progression of disease are the most common causes for reoperation, but progressive natural increase in valve gradient accounts for a substantial proportion as well.
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U2 - 10.1016/j.athoracsur.2013.11.036
DO - 10.1016/j.athoracsur.2013.11.036
M3 - Article
C2 - 24680032
AN - SCOPUS:84899913033
SN - 0003-4975
VL - 97
SP - 1539
EP - 1548
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 5
ER -