Key result
Mechanical TARR yields ~83% 7-year survival but is linked to high embolic event rates.
Why the study?
What are the long-term survival and complication rates of total aortic root replacement using mechanical valve grafts in patients with isolated aortic root dilatation?
Cohort (n=100)
What are the long-term survival and complication rates of total aortic root replacement using mechanical valve grafts in patients with isolated aortic root dilatation?
Total aortic root replacement with mechanical valves yields excellent long-term survival but is associated with a high rate of thromboembolic events, suggesting a potential role for combined aspirin and oral anticoagulation.
High embolic rates may limit mechanical root graft use; leaves open optimized antithrombotic strategies for prospective trials.
AIM: As valve-sparing procedures gain increasing popularity, the long-term results of the total aortic root replacement (TARR) were evaluated using mechanical valve grafts in selected patients. METHODS AND RESULTS: From January 1993 to December 2003, 100 patients (87 men), aged >65 years (mean 51 (SD 10.4 years), presenting with isolated aortic root dilatation with or without aortic valve insufficiency, undergoing elective root replacement using a mechanical valve graft were reviewed. The aetiology of aortic root disease was degenerative in 69 patients and related to the bicuspid aortic valve in 31 patients. In 11 patients, concomitant coronary artery bypass graft was performed. Hospital mortality was 4%. Overall survival was 93.9% (2.4%), 89.1% (3.5%) and 83.2% (5.2%) at 1, 5 and 7 years, respectively. 14 patients experienced 45 embolic events (3.21 (2.64) events/patient; range: 1-10 events). Thus, the linearised rate of embolic events was 10.3 per 100 patient-years (95% confidence interval (CI) 7.29 to 13.31). The actuarial embolism-free survival was 96.6% (1.9%), 77.1% (6%) and 74.3% (6.4%) at 1, 5 and 7 years, respectively. The linearised rate of bleeding events was 2.2 per 100 patient-years (95% CI 0.87 to 3.71). Actuarial bleeding free survival was 95.6% (2.1%), 93.2% (2.6%) and 87.7% (5.8%) at 1, 5 and 7 years. respectively. None of the patients required reoperation and no cases of structural or non-structural valve dysfunction were observed. CONCLUSIONS: TARR using mechanical valve grafts yields excellent survival results in selected patients. However, a high rate of minor thromboembolic events was recorded. Aspirin in combination with oral anticoagulants might be of potential interest in these patients.
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Radu et al. (2006) conducted a cohort in Isolated aortic root dilatation with or without aortic valve insufficiency (n=100). Total aortic root replacement (TARR) using mechanical valve grafts was evaluated on Embolic events (95% CI 7.29 to 13.31). Total aortic root replacement using mechanical valve grafts yielded 83.2% survival at 7 years but had a high linearized rate of embolic events (10.3 per 100 patient-years; 95% CI 7.29-13.31).
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