Key result
In patients with tricuspid aortic valves undergoing valve-sparing reimplantation, the necessity of cusp repair increased significantly with the degree of preoperative aortic regurgitation (P<0.001).
Why the study?
The authors sought to analyse the influence of preoperative aortic regurgitation on the necessity of cusp repair during valve-sparing reimplantation in patients with tricuspid aortic valves and evaluate their impact on long-term outcomes.
Does preoperative aortic regurgitation and cusp repair impact long-term outcomes in patients with tricuspid aortic valves undergoing valve-sparing root reimplantation?
Cohort (n=303)
No
Does preoperative aortic regurgitation and cusp repair impact long-term outcomes in patients with tricuspid aortic valves undergoing valve-sparing root reimplantation?
p-value: p=<0.001
In patients with tricuspid aortic valves undergoing valve-sparing reimplantation, cusp repair is frequently necessary and increases with preoperative AR severity, but does not negatively impact long-term survival or freedom from reoperation.
Cusp repair needs may rise with AR severity without harming survival; leaves open durability questions in valve-sparing reimplantation.
OBJECTIVES: Our goal was to analyse the influence of preoperative aortic regurgitation (AR) on the necessity of cusp repair during valve-sparing reimplantation (VSR). We focused on patients with tricuspid aortic valves (TAV) and evaluated the impact of AR and cusp repair on long-term outcomes. METHODS: From March 1998 to December 2018, a total of 512 consecutive patients underwent VSR at our institution; of these, 303 had a TAV. The mean age was 53 ± 15 years, and the median follow-up was 6.12 years. The rate and type of cusp repair were analysed based on preoperative AR. Time-to-event analysis was performed, as well as risk of death, reoperation and AR recurrence. RESULTS: Cusp repair was necessary in 168 (55.4%) patients; the rate rose significantly as AR grade increased (P < 0.001). In-hospital mortality was 1% (n = 3). At 5 and 10 years, overall survival was 92 ± 2% and 75 ± 5%, respectively. Freedom from valve reoperation was 95 ± 2% and 90 ± 3%. Freedom from AR >2+ and AR >1+ at 10 years was 88 ± 4% and 70.4 ± 4.6%, respectively. Independent predictors of death included age, New York Heart Association functional class and type-A aortic dissection. Predictors of AR greater than mild included previous cardiac surgery and severe preoperative AR. CONCLUSION: In patients with TAV receiving VSR, the necessity of cusp repair increased with the degree of preoperative AR. Preoperative AR and cusp repair do not impact long-term survival and aortic valve reoperation, but severe preoperative AR and multiple cusp repair increase the risk of recurrent moderate-to-severe AR. Overall, cusp repair seems to attenuate the negative impact of preoperative AR for at least 1 decade in a majority of patients.
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Tamer et al. (2020) conducted a cohort in Tricuspid aortic valve requiring valve-sparing root reimplantation (n=303). Preoperative aortic regurgitation (AR) vs. Lower grades of preoperative AR was evaluated on Necessity of cusp repair (p=<0.001). In patients with tricuspid aortic valves undergoing valve-sparing reimplantation, the necessity of cusp repair increased significantly with the degree of preoperative aortic regurgitation (P<0.001).
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