Aortic valve cusp repair does not affect durability of modified aortic valve reimplantation for tricuspid aortic valves

Figures

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  Need for reoperation by need for cusp repair at the time of aortic valve reimplantation.

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  Figure 1. CONSORT-style diagram of patients undergoing tricuspid aortic valve–sparing root replacement with or without cusp repair.

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  Figure 2. Steps in modified reimplantation with pledgeted sutures, a Hegar dilator for normal BSA annular size (not shown), and completion of reimplantation/repair.

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  Figure 3. Comparison of longitudinal echocardiographic outcomes after tricuspid aortic valve–sparing root replacement with or without cusp repair in the matched cohorts. Symbols represent data grouped (without regard to repeated measurements) within time frames to provide a crude verification of model fit. A, Postoperative prevalence of AR grades. Solid lines represent longitudinal trend in AR grades. B, Temporal trend of postoperative aortic valve mean gradient. Solid line represents unadjusted estimates of temporal trend of postoperative aortic valve mean gradient enclosed within a 68% confidence band. AR, Aortic regurgitation.

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  Figure 4. Freedom from aortic valve reoperation after tricuspid aortic valve–sparing root replacement with or without cusp repair in the matched cohorts. Each symbol represents a Kaplan–Meier estimate of the event, and vertical bars are 68% confidence limits equivalent to ±1 standard error. Numbers below horizontal axis are patients remaining at risk. AV, Aortic valve.

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  Figure 5. Survival after tricuspid aortic valve–sparing root replacement with or without cusp repair in the matched cohorts. Each symbol represents a Kaplan–Meier estimate of the event, and vertical bars are 68% confidence limits equivalent to ±1 standard error. Numbers below horizontal axis are patients remaining at risk.

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  Figure 6. Patients with tricuspid aortic valves undergoing valve reimplantation during valve-sparing aortic root repair may also undergo cusp repair. Cusp repair is durable and does not adversely affect long-term valve hemodynamics. AV, Aortic valve; AR, aortic regurgitation; CuspRpr, cusp repair; no-CuspRpr, no cusp repair.

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  Figure E1. Temporal trend of number of patients undergoing tricuspid aortic valve–sparing root replacement with cusp repair (blue line and symbols) or without cusp repair (red lines and symbols) over the study period. Symbols are yearly number of cases in each group.

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  Figure E2. Echocardiographic follow-up across study period showing number of patients with echocardiograms over time and number of follow-up echocardiograms available at and beyond designated time points. A, Tricuspid aortic valve–sparing root reimplantation with aortic valve cusp repair. A total of 658 echocardiograms were evaluated for 178 patients. B, Tricuspid aortic valve–sparing root reimplantation without aortic valve cusp repair. A total of 1855 echocardiograms were evaluated for 559 patients.

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  Figure E3. Quality of propensity score matching of patients undergoing tricuspid aortic valve–sparing root replacement with aortic valve cusp repair (blue bars) or without cusp repair (red bars). A, Mirrored histogram of distribution of propensity scores for both groups. Shaded areas represent matched patient pairs. B, Standardized differences of selected variables before and after matching. Vertical dashed lines at −10% and +10% indicate boundaries of desirable matching. AV, Aortic valve; LV, left ventricle; LVEDVi, left ventricular end-diastolic volume index; BUN, blood urea nitrogen; LVESVi, left ventricular end-systolic volume index; HTN, hypertension; CTD, connective tissue disease.