Interv Akut Kardiol. 2018;17(1):8-13 | DOI: 10.36290/kar.2018.003

Risk factors for failure of aortic valve-sparing procedures

Martin Tuna¹, Pavel Žáček¹, Mikita Karalko¹, Miroslav Brtko¹, Rudolf Praus², Pavel Nedbal³, Peter Telekes³, Jiří Vondrák⁴, Jan Vojáček¹

¹ Kardiochirurgická klinika, Fakultní nemocnice Hradec Králové, Lékařská fakulta v Hradci Králové, Univerzita Karlova

² I. interní kardioangiologická klinika, Fakultní nemocnice Hradec Králové, Lékařská fakulta v Hradci Králové, Univerzita Karlova

³ Kardiocentrum, Krajská Nemocnice Liberec, a.s.

⁴ Kardiologické oddělení, Nemocnice Pardubického kraje, a.s.

Aim: To evaluate medium to long-term outcomes of aortic valve – sparing procedures and identify risk factors for procedure failure.

Methods: From 11/2007 to 10/2017, a total of 198 aortic valve sparing operations were performed at our department. The meanage of patients was 48.4±13.5 years. Preoperatively, the mean grade of aortic regurgitation was 3.4±1.1. Aortic root dilation andcusp prolapse were main causes of aortic regurgitation (in 106 and 92 cases, respectively).

Results: Out of a total of 198 operations, supracoronary aortic root replacement (24), reimplantation of the aortic valve (11), remodelingof the aortic root (71) combined in 66 patients with implantation of the external annuloplasty ring, and 92 aortic cuspinterventions were performed. Thirty-day mortality was 0 %. The median follow-up is 2.8 years (194 patients). During this period, 4 patients died. Nineteen patients were reoperated (9.5 %); 15 for recurrent aortic regurgitation, 1 for development of aorticstenosis, 2 for vascular graft infection and 1 for aortic root pseudoaneurysm. At reoperation 1 valve repair, 14 replacements witha mechanical prosthesis and 1 with a bioprosthesis (1 with pseudoaneurysm closure), and 2 aortic root replacements with a homograftwere performed. The leading cause of aortic regurgitation recurrence was cusp reprolapse and aortic annulus redilation(9 cases). Aortic valve restriction and retraction were other causes of repair failure (6 cases).

Conclusion: Aortic valve-sparing operations should be considered the method of choice in selected patients. Echocardiographycorrectly distinguishes the anatomy suitable for aortic valve repair, determines the optimal type of procedure, evaluates its outcome,and identifies the presence of risk factors for failure of aortic valve reconstruction.

Keywords: aortic valve repair, transesophageal echocardiography, aortic regurgitation, bicuspid aortic valve

Received: January 3, 2018; Accepted: February 3, 2018; Published: April 1, 2018  Show citation