April 19, 2010European Journal of Cardio-Thoracic Surgery
Should root replacement with aortic valve-sparing be offered to patients with bicuspid valves or severe aortic regurgitation?☆
Key result
Aortic valve-sparing operations yielded 97.8% 5-year survival, with 5-year freedom from re-operation of 100% for BAV, 98% for TAV with <severe AR, and 82.7% for TAV with severe AR (p=0.07).
Why the study?
Does root replacement with aortic valve-sparing provide acceptable survival and freedom from re-operation in patients with bicuspid aortic valves or severe aortic regurgitation?
Population
102 patients undergoing aortic valve-sparing procedures for ascending aortic aneurysm or dissection…
Comparison
Root replacement with aortic valve-sparing. vs Comparison among three groups based on baseline…
Design
Cohort
Follow-up
5 years
Authors
Discussion
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Member takes
Implication
Supports valve-sparing root replacement in BAV and severe AR; hypothesis-generating and requires randomized confirmation before practice change.
Study Design
Type
Cohort (n=102)
Structured PICO
Does root replacement with aortic valve-sparing provide acceptable survival and freedom from re-operation in patients with bicuspid aortic valves or severe aortic regurgitation?
P
Population
102 patients (mean age 47 years) undergoing aortic valve-sparing procedures for ascending aortic aneurysm or dissection, followed prospectively for 5 years.
E
Exposure
Root replacement with aortic valve-sparing (remodelling in 27.5%, reimplantation in 72.5%, and concomitant cusp repair in 29.4%).
C
Comparator
Comparison among three groups based on baseline valve pathology: bicuspid aortic valve (BAV), tricuspid aortic valve (TAV) with AR less than severe, and TAV with severe AR.
O
Outcome
Actuarial 5-years' survival, freedom from aortic valve-related re-operation, and freedom from AR more than mild at 5 years.hard clinical
Main Result
Absolute Event Rate: 82.7% vs 98%
p-value: p=0.07
Root replacement with aortic valve-sparing offers excellent survival and acceptable re-operation rates even in patients with bicuspid aortic valves or severe aortic regurgitation.
Cite This Study
Badiu et al. (2010) conducted a cohort in Ascending aortic aneurysm or dissection with bicuspid aortic valve or severe aortic regurgitation (n=102). Aortic valve-sparing procedures in severe AR or BAV vs. Tricuspid aortic valve with less than severe AR was evaluated on Actuarial 5-year freedom from aortic valve-related re-operation (p=0.07). Aortic valve-sparing operations yielded 97.8% 5-year survival, with 5-year freedom from re-operation of 100% for BAV, 98% for TAV with <severe AR, and 82.7% for TAV with severe AR (p=0.07).