P122. Efficacy of Aortic Valve Resuspension for Aortic Regurgitation Following Dissection of Aortic Root in Acute Type A Aortic Dissection
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
Wakayama City, Wakayama
Japan - Contact Me
Hiroyuki Hara is a surgeon in Division of Cardiovascular Surgery at Japan Red Cross Society Wakayama Medical Center in Wakayama of Japan.
Research focus in aortic, valvular and coronary diseases.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
Objective: We assessed the long-term outcomes after aortic valve resuspension for aortic regurgitation (AR) following dissection of aortic root in patients with acute type A aortic dissection (ATAAD).
Methods: A total of 168 first supracoronary aortic replacement for ATAAD were performed from January 2006 to December 2021. We excluded six patients without preoperative CT, three patients who had no aortic root dissection by preoperative CT but underwent aortic valve resuspension depending on the intraoperative findings, and 32 patients who had aortic root dissection by CT but did not undergo aortic valve resuspension. Regarding surgical technique, adhesion of proximal false lumen in dissected aortic root or dissected ascending aorta were basically performed using surgical adjuncts (gelatin-resorcin-formalin glue, BioGlue or fibrin glue). If all of three Valsalva sinuses were affected by the dissection and there was no significant aortic valve leaflet pathology, aortic valve resuspension was performed using a pledgeted U-stitch just above each top of aortic valve commissures. If Valsalva sinuses were affected only partially or were not affected by the dissection, just adhesion of proximal false lumen was performed using surgical adjuncts. The patients, who had no aortic root dissection by CT and underwent just adhesion of proximal false lumen, were included in the non-dissection group (N=54) and the patients, who had aortic root dissection by CT and underwent aortic valve resuspension adding to proximal adhesion, were dissection group (N=73).
Results: The rate of preoperative moderate or severe AR in the dissection group was significantly higher than that in non-dissection group (21.2% vs. 2.9%, P=0.007%). However, the rates of moderate or severe AR after surgical repair for ATAAD in both groups were comparable (3.0% vs. 0%, P=0.19). The cumulative 10-year incidence of all-cause death was similar between non-dissection group and dissection group (41.5% vs. 41.5%, log-rank P=0.66). The cumulative 10-year incidence of a composite of cardiac death / heart failure / aortic valve replacement (AVR) for deterioration of AR was also comparable between both groups (17.3% vs. 17.0%, log-rank P=0.64). The cumulative 10-year incidence of a composite of moderate or severe AR deteriorating during follow-up or AVR for deterioration of AR in dissection group was significantly higher than that in non-dissection group (70.9% and 20.8%, log-rank P=0.04). After adjustment with confounders, there was no difference between both groups in risk for all-cause death (HR 1.12, 95%CI 0.52 to 2.37, P=0.78), and in risk for a composite of cardiac death / heart failure / AVR for deterioration of AR (HR 1.32, 95%CI 0.41 to 4.21, P=0.64), while higher risk of a composite of moderate or severe AR deteriorating during follow-up or AVR for deterioration of AR in dissection group was significant in comparison with non-dissection group (HR 20.7, 95%CI 1.99 to 214, P=0.01).
Conclusions: Aortic valve resuspension for AR following aortic root dissection could improve valve competency in short-term and overall long-term survival rate is comparable with that in patients without aortic root dissection. However, aortic root dissection repaired with aortic valve resuspension is associated with significant higher risk of deterioration of AR in long-term follow-up. Aortic valve resuspension seemed an acceptable option for selected patients with AR following aortic root dissection.
Authors
Hiroyuki Hara (1), Naoki Kanemitsu (1), Yosuke Sugita (1), Keita Yano (1), Shinya Takimoto (1), Kenji Minatoya (2)
Institutions
(1) Division of Cardiovascular Surgery, Japan Red Cross Society Wakayama Medical Center, Wakayama City, Japan, (2) Kyoto University Hospital, Kyoto, outside of US
Methods: A total of 168 first supracoronary aortic replacement for ATAAD were performed from January 2006 to December 2021. We excluded six patients without preoperative CT, three patients who had no aortic root dissection by preoperative CT but underwent aortic valve resuspension depending on the intraoperative findings, and 32 patients who had aortic root dissection by CT but did not undergo aortic valve resuspension. Regarding surgical technique, adhesion of proximal false lumen in dissected aortic root or dissected ascending aorta were basically performed using surgical adjuncts (gelatin-resorcin-formalin glue, BioGlue or fibrin glue). If all of three Valsalva sinuses were affected by the dissection and there was no significant aortic valve leaflet pathology, aortic valve resuspension was performed using a pledgeted U-stitch just above each top of aortic valve commissures. If Valsalva sinuses were affected only partially or were not affected by the dissection, just adhesion of proximal false lumen was performed using surgical adjuncts. The patients, who had no aortic root dissection by CT and underwent just adhesion of proximal false lumen, were included in the non-dissection group (N=54) and the patients, who had aortic root dissection by CT and underwent aortic valve resuspension adding to proximal adhesion, were dissection group (N=73).
Results: The rate of preoperative moderate or severe AR in the dissection group was significantly higher than that in non-dissection group (21.2% vs. 2.9%, P=0.007%). However, the rates of moderate or severe AR after surgical repair for ATAAD in both groups were comparable (3.0% vs. 0%, P=0.19). The cumulative 10-year incidence of all-cause death was similar between non-dissection group and dissection group (41.5% vs. 41.5%, log-rank P=0.66). The cumulative 10-year incidence of a composite of cardiac death / heart failure / aortic valve replacement (AVR) for deterioration of AR was also comparable between both groups (17.3% vs. 17.0%, log-rank P=0.64). The cumulative 10-year incidence of a composite of moderate or severe AR deteriorating during follow-up or AVR for deterioration of AR in dissection group was significantly higher than that in non-dissection group (70.9% and 20.8%, log-rank P=0.04). After adjustment with confounders, there was no difference between both groups in risk for all-cause death (HR 1.12, 95%CI 0.52 to 2.37, P=0.78), and in risk for a composite of cardiac death / heart failure / AVR for deterioration of AR (HR 1.32, 95%CI 0.41 to 4.21, P=0.64), while higher risk of a composite of moderate or severe AR deteriorating during follow-up or AVR for deterioration of AR in dissection group was significant in comparison with non-dissection group (HR 20.7, 95%CI 1.99 to 214, P=0.01).
Conclusions: Aortic valve resuspension for AR following aortic root dissection could improve valve competency in short-term and overall long-term survival rate is comparable with that in patients without aortic root dissection. However, aortic root dissection repaired with aortic valve resuspension is associated with significant higher risk of deterioration of AR in long-term follow-up. Aortic valve resuspension seemed an acceptable option for selected patients with AR following aortic root dissection.
Authors
Hiroyuki Hara (1), Naoki Kanemitsu (1), Yosuke Sugita (1), Keita Yano (1), Shinya Takimoto (1), Kenji Minatoya (2)
Institutions
(1) Division of Cardiovascular Surgery, Japan Red Cross Society Wakayama Medical Center, Wakayama City, Japan, (2) Kyoto University Hospital, Kyoto, outside of US
Presentation Duration
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