Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Does Additional Aortic Procedure Carry a Higher Risk in Patients Undergoing Aortic Valve Replacement?

  • Kim, Tae-Hun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Park, Kay-Hyun (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Yoo, Jae Suk (Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jae Hang (Dongguk University Ilsan Hospital, Dongguk University College of Medicine) ;
  • Lim, Cheong (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • Received : 2012.03.21
  • Accepted : 2012.05.19
  • Published : 2012.10.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: With growing attention to the aortopathy associated with aortic valve diseases, the number of candidates for accompanying ascending aorta and/or root replacement is increasing among the patients who require aortic valve replacement (AVR). However, such procedures have been considered more risky than AVR alone. This study aimed to compare the surgical outcome of isolated AVR and AVR combined with aortic procedures. Materials and Methods: A total of 86 patients who underwent elective AVR between 2004 and June 2010 were divided into two groups: complex AVR (n=50, AVR with ascending aorta replacement in 24 and the Bentall procedure in 26) and simple AVR (n=36). Preoperative characteristics, surgical data, intra- and postoperative allogenic blood transfusion requirement, the postoperative clinical course, and major complications were retrospectively reviewed and compared. Results: The preoperative mean logistic European System for Cardiac Operative Risk Evaluation (%) did not differ between the groups: $11.0{\pm}7.8%$ in the complex AVR group and $12.3{\pm}8.0%$ in the simple AVR group. Although complex AVR required longer cardiopulmonary bypass ($152.4{\pm}52.6$ minutes vs. $109.7{\pm}22.7$ minutes, p=0.001), the quantity of allogenic blood products did not differ ($13.4{\pm}14.7$ units vs. $13.9{\pm}11.2$ units). There was no mortality, mechanical circulatory support, stroke, or renal failure requiring hemodialysis/filtration. No difference was found in the incidence of bleeding (40% vs. 33.3%) which was defined as red blood cell transfusion ${\geq}5$ units, reoperation, or intentional delayed closure. The incidence of mediastinitis (2.0% vs. 0%), ventilator ${\geq}24$ hours (4.0% vs. 2.8%), atrial fibrillation (18.0% vs. 25.0%), mean intensive care unit stay (34.5 hours vs. 38.8 hours), and median hospital stay (8 days vs. 7 days) did not differ, either. Conclusion: AVR combined with additional aortic or root replacement showed an excellent outcome and recovery course equivalent to that after isolated AVR.

Keywords

References

  1. Vallely MP, Semsarian C, Bannon PG. Management of the ascending aorta in patients with bicuspid aortic valve disease. Heart Lung Circ 2008;17:357-363. https://doi.org/10.1016/j.hlc.2008.01.007
  2. Borger MA, Preston M, Ivanov J, et al. Should the ascending aorta be replaced more frequently in patients with bicuspid aortic valve disease? J Thorac Cardiovasc Surg 2004; 128:677-683. https://doi.org/10.1016/j.jtcvs.2004.07.009
  3. Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/ AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. J Am Coll Cardiol 2010;55:e27-e129. https://doi.org/10.1016/j.jacc.2010.02.015
  4. Renzulli A, de Feo M, della Corte A, Ismeno G. Conservative treatment of dilated ascending aorta: a new technique. Heart Views 1999;1:163-169.
  5. Nancarrow PA, Higgins CB. Progressive thoracic aortic dilatation after aortic valve replacement. AJR Am J Roentgenol 1984;142:669-672. https://doi.org/10.2214/ajr.142.4.669
  6. Andrus BW, O'Rourke DJ, Dacey LJ, Palac RT. Stability of ascending aortic dilatation following aortic valve replacement. Circulation 2003;108 Suppl 1:II295-II299.
  7. Dougenis D, Daily BB, Kouchoukos NT. Reoperations on the aortic root and ascending aorta. Ann Thorac Surg 1997;64:986-992. https://doi.org/10.1016/S0003-4975(97)00626-7
  8. Prenger K, Pieters F, Cheriex E. Aortic dissection after aortic valve replacement: incidence and consequences for strategy. J Card Surg 1994;9:495-498. https://doi.org/10.1111/j.1540-8191.1994.tb00882.x
  9. Michel PL, Acar J, Chomette G, Iung B. Degenerative aortic regurgitation. Eur Heart J 1991;12:875-882.
  10. Russo CF, Mazzetti S, Garatti A, et al. Aortic complications after bicuspid aortic valve replacement: long-term results. Ann Thorac Surg 2002;74:S1773-S1776. https://doi.org/10.1016/S0003-4975(02)04261-3
  11. Bauer M, Pasic M, Meyer R, et al. Morphometric analysis of aortic media in patients with bicuspid and tricuspid aortic valve. Ann Thorac Surg 2002;74:58-62. https://doi.org/10.1016/S0003-4975(02)03650-0
  12. Januzzi JL, Isselbacher EM, Fattori R, et al. Characterizing the young patient with aortic dissection: results from the International Registry of Aortic Dissection (IRAD). J Am Coll Cardiol 2004;43:665-669. https://doi.org/10.1016/j.jacc.2003.08.054
  13. Yasuda H, Nakatani S, Stugaard M, et al. Failure to prevent progressive dilation of ascending aorta by aortic valve replacement in patients with bicuspid aortic valve: comparison with tricuspid aortic valve. Circulation 2003;108 Suppl 1: II291-II294.
  14. Natsuaki M, Itoh T, Rikitake K, Okazaki Y, Naitoh K. Aortic complications after aortic valve replacement in patients with dilated ascending aorta and aortic regurgitation. J Heart Valve Dis 1998;7:504-509.
  15. Pieters FA, Widdershoven JW, Gerardy AC, Geskes G, Cheriex EC, Wellens HJ. Risk of aortic dissection after aortic valve replacement. Am J Cardiol 1993;72:1043-1047. https://doi.org/10.1016/0002-9149(93)90860-F
  16. McKellar SH, Michelena HI, Li Z, Schaff HV, Sundt TM 3rd. Long-term risk of aortic events following aortic valve replacement in patients with bicuspid aortic valves. Am J Cardiol 2010;106:1626-1633. https://doi.org/10.1016/j.amjcard.2010.07.043
  17. Braverman AC, Beardslee MA. The bicuspid aortic valve. In: Otto CM, Bonow RO, editors. Valvular heart disease: a companion to Braunwald's heart disease. 3rd ed. Philadelphia: Saunders/Elsevier; 2009. p. 169-186.
  18. Tsutsumi K, Inoue Y, Hashizume K, Kimura N, Takahashi R. Risk factor analysis for acute type A aortic dissection after aortic valve replacement. Gen Thorac Cardiovasc Surg 2010;58:601-605. https://doi.org/10.1007/s11748-010-0658-z
  19. American College of Cardiology; American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease); Society of Cardiovascular Anesthesiologists, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing Committee to Revise the 1998 guidelines for the management of patients with valvular heart disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 2006;48:e1-e148. https://doi.org/10.1016/j.jacc.2006.05.021
  20. Glower DD. Indications for ascending aortic replacement size alone is not enough. J Am Coll Cardiol 2011;58:585-586. https://doi.org/10.1016/j.jacc.2011.03.041
  21. Elefteriades JA, Farkas EA. Thoracic aortic aneurysm clinically pertinent controversies and uncertainties. J Am Coll Cardiol 2010;55:841-857. https://doi.org/10.1016/j.jacc.2009.08.084
  22. Chung S, Park PW, Choi MS, et al. Surgical experience of ascending aorta and aortic valve replacement in patient with calcified aorta. Korean J Thorac Cardiovasc Surg 2012;45: 24-29. https://doi.org/10.5090/kjtcs.2012.45.1.24
  23. van Putte BP, Ozturk S, Siddiqi S, Schepens MA, Heijmen RH, Morshuis WJ. Early and late outcome after aortic root replacement with a mechanical valve prosthesis in a series of 528 patients. Ann Thorac Surg 2012;93:503-509. https://doi.org/10.1016/j.athoracsur.2011.07.089
  24. Hughes GC, Zhao Y, Rankin JS, et al. Effects of institutional volumes on operative outcomes for aortic root replacement in North America. J Thorac Cardiovasc Surg 2012 Feb 3 [Epub].
  25. Etz CD, Homann TM, Silovitz D, et al. Long-term survival after the Bentall procedure in 206 patients with bicuspid aortic valve. Ann Thorac Surg 2007;84:1186-1193. https://doi.org/10.1016/j.athoracsur.2007.03.057
  26. Etz CD, Bischoff MS, Bodian C, et al. The Bentall procedure: is it the gold standard? A series of 597 consecutive cases. J Thorac Cardiovasc Surg 2010;140(6 Suppl):S64-S70. https://doi.org/10.1016/j.jtcvs.2010.07.033
  27. Taylor NE, O'Brien S, Edwards FH, Peterson ED, Bridges CR. Relationship between race and mortality and morbidity after valve replacement surgery. Circulation 2005;111:1305-1312 https://doi.org/10.1161/01.CIR.0000157737.92938.D8

Cited by

  1. Managing Thoracic Aortic Aneurysm in Patients with Bicuspid Aortic Valve Based on Aortic Root-Involvement vol.8, pp.None, 2012, https://doi.org/10.3389/fphys.2017.00397