Mid-term Results of Sleeve Procedure for Repairing Aortic Regurgitation with Mild to Moderate Aortic Root Dilatation
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0213
Submission Type:
Abstract Submission
Authors:
Junichiro Eishi (1), Takashi Miura (2), Ichiro Matsumaru (3), Kikuko Obase (4), Kiyoyuki Eishi (5)
Institutions:
(1) N/A, N/A, (2) N/A, Nagasaki, Japan, (3) Nagasaki University Hospital, Nagasaki, Japan, Nagasaki, Japan, (4) Nagasaki University Hospital, Nagasaki, N/A, (5) Hakujyuji Hospital, N/A
Submitting Author:
Junichiro Eishi
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Co-Author(s):
Takashi Miura
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Ichiro Matsumaru
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Nagasaki University Hospital, Nagasaki, Japan
Nagasaki University Hospital, Nagasaki, Japan
Kikuko Obase
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Nagasaki University Hospital
Nagasaki University Hospital
Kiyoyuki Eishi
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Hakujyuji Hospital
Hakujyuji Hospital
Presenting Author:
Junichiro Eishi
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Abstract:
[Objective] For severe aortic valve regurgitation (AR), valve sparing root replacement, represented by David procedure, is performed in cases of severe root dilatation. However, there is no established surgical method for cases of mild to moderate dilatation. We performed Sleeve procedure and compared its efficacy with David procedure.
[Methods] We analyzed 55 cases of Sleeve procedure (S group) and 59 cases of David procedure (D group) performed at our hospital between 2012 and 2021. We considered the S group with mild to moderate root dilatation to potentially pose more challenges in cusp repair than the D group. The difficulty of the cusp repair technique was evaluated by scoring system as follows [non-prolapsed valve central plication (CP); 0.5 points, prolapsed cusp suspension with Neo-chord; 0.5 points, prolapsed valve or fusion cusp CP; 1 point, prolapsed reinforcement; 1 point, patch repair; 2 points, patch reconstruction around commissure; 3 points].
[Results] There were no significant differences in age at surgery (S group 62(46-71) years vs D group 59(42-69) years). The preoperative annular diameter (24.2(23.0-27.0) mm vs 24.0(22.0-27.0) mm, P=0.216) was equivalent, but Valsalva sinus diameter (38.0(35.0-41.5) mm vs48.5(43.0-54.0), P<.0001) and Sino tubular junction (STJ) diameter (31.0(27.0-34.0) mm vs 40.0(35.0-44.0) mm, P<.0001) were significantly larger in the D group. Although there was no statistically significant difference, the prevalence of AR beyond moderate to severe was higher in the S group than in the D group(44(80%) vs 38(66%), P=0.083). The percentage of cusp repair difficulty scores higher than 2.5 points were significantly higher in S group (30(54.6%) vs 11(18.6%), P<.0001). There were no in-hospital deaths in either group. The 6-year survival rate (100% vs 93%±5%), reoperation free rate (90±4% vs 95±4%), and more moderate to severe AR recurrence free rate (92%±4% vs 95%±4%) were equivalent between the two groups(S group(n=55), D group(n=59)). There were 7 cases of AR recurrence (5 in S group and 2 in D group), and in the S group, cases of recurrence had larger preoperative annular diameter (24.0(22.6-26.0) mm vs 31.0(27.0-35.8) mm).
[Conclusion] Sleeve procedure has been applied to cases with more complex valve repair, however its mid-term results are equivalent to David procedure and it is expected to be an excellent total root remodeling for severe AR with mild to moderate root dilatation.
[Methods] We analyzed 55 cases of Sleeve procedure (S group) and 59 cases of David procedure (D group) performed at our hospital between 2012 and 2021. We considered the S group with mild to moderate root dilatation to potentially pose more challenges in cusp repair than the D group. The difficulty of the cusp repair technique was evaluated by scoring system as follows [non-prolapsed valve central plication (CP); 0.5 points, prolapsed cusp suspension with Neo-chord; 0.5 points, prolapsed valve or fusion cusp CP; 1 point, prolapsed reinforcement; 1 point, patch repair; 2 points, patch reconstruction around commissure; 3 points].
[Results] There were no significant differences in age at surgery (S group 62(46-71) years vs D group 59(42-69) years). The preoperative annular diameter (24.2(23.0-27.0) mm vs 24.0(22.0-27.0) mm, P=0.216) was equivalent, but Valsalva sinus diameter (38.0(35.0-41.5) mm vs48.5(43.0-54.0), P<.0001) and Sino tubular junction (STJ) diameter (31.0(27.0-34.0) mm vs 40.0(35.0-44.0) mm, P<.0001) were significantly larger in the D group. Although there was no statistically significant difference, the prevalence of AR beyond moderate to severe was higher in the S group than in the D group(44(80%) vs 38(66%), P=0.083). The percentage of cusp repair difficulty scores higher than 2.5 points were significantly higher in S group (30(54.6%) vs 11(18.6%), P<.0001). There were no in-hospital deaths in either group. The 6-year survival rate (100% vs 93%±5%), reoperation free rate (90±4% vs 95±4%), and more moderate to severe AR recurrence free rate (92%±4% vs 95%±4%) were equivalent between the two groups(S group(n=55), D group(n=59)). There were 7 cases of AR recurrence (5 in S group and 2 in D group), and in the S group, cases of recurrence had larger preoperative annular diameter (24.0(22.6-26.0) mm vs 31.0(27.0-35.8) mm).
[Conclusion] Sleeve procedure has been applied to cases with more complex valve repair, however its mid-term results are equivalent to David procedure and it is expected to be an excellent total root remodeling for severe AR with mild to moderate root dilatation.
Aortic Symposium:
Aortic Root
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