Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Surgical Management of Aortic Root Dilatation with Advanced Aortic Regurgitation: Bentall Operation versus Valve-sparing Procedure

  • Lim, Ju-Yong (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Joon-Bum (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, Sung-Ho (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choo, Suk-Jung (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Chung, Cheol-Hyun (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jae-Won (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2011.09.21
  • Accepted : 2011.11.11
  • Published : 2012.06.05
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Abstract

Background: Although the aortic valve-sparing procedure has gained popularity in recent years, it still remains challenging in patients with advanced aortic regurgitation (AR). We compared the long-term outcomes of the aortic valve-sparing procedure with the Bentall operation in patients with advanced aortic regurgitation secondary to aortic root dilatation. Materials and Methods: A retrospective review of 120 patients who underwent surgery for aortic root dilatation with moderate to severe AR between January 1999 and June 2009 was performed. Forty-eight patients underwent valve-sparing procedures (valve-sparing group), and 72 patients underwent the Bentall procedure (Bentall group). The two groups' overall survival, valve-related complications, and aortic valve function were compared. Results: The mean follow-up duration was $4.9{\pm}3.1$ years. After adjustment, the valve-sparing group had similar risks of death (hazard ratio [HR], 0.61; p=0.45), and valve related complications (HR, 1.27; p=0.66). However, a significant number of patients developed moderate to severe AR in the valve-sparing group at a mean of $4.4{\pm}2.5$ years of echocardiographic follow-up (p<0.001). Conclusion: Both the Bentall operation and aortic valve-sparing procedure showed comparable long-term clinical results in patients with advanced aortic regurgitation with aortic root dilatation. However, recurrent advanced aortic regurgitation was more frequently observed following valve-sparing procedures.

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References

  1. Bentall H, De Bono A. A technique for complete replacement of the ascending aorta. Thorax 1968;23:338-9. https://doi.org/10.1136/thx.23.4.338
  2. Hopkins RA. Aortic valve leaflet sparing and salvage surgery: evolution of techniques for aortic root reconstruction. Eur J Cardiothorac Surg 2003;24:886-97. https://doi.org/10.1016/S1010-7940(03)00619-5
  3. Zehr KJ, Orszulak TA, Mullany CJ, et al. Surgery for aneurysms of the aortic root: a 30-year experience. Circulation 2004;110:1364-71. https://doi.org/10.1161/01.CIR.0000141593.05085.87
  4. Yacoub MH, Gehle P, Chandrasekaran V, Birks EJ, Child A, Radley-Smith R. Late results of a valve-preserving operation in patients with aneurysms of the ascending aorta and root. J Thorac Cardiovasc Surg 1998;115:1080-90. https://doi.org/10.1016/S0022-5223(98)70408-8
  5. Normand SL. Evaluating the optimal timing of angiography: landmark or off the mark? Circulation 2007;116:2656-7. https://doi.org/10.1161/CIRCULATIONAHA.107.741132
  6. Robins JM, Hernan MA, Brumback B. Marginal structural models and causal inference in epidemiology. Epidemiology 2000;11:550-60. https://doi.org/10.1097/00001648-200009000-00011
  7. David TE, Feindel CM, Webb GD, Colman JM, Armstrong S, Maganti M. Long-term results of aortic valve-sparing operations for aortic root aneurysm. J Thorac Cardiovasc Surg 2006;132:347-54. https://doi.org/10.1016/j.jtcvs.2006.03.053
  8. David TE, Feindel CM, Armstrong S, Maganti M. Replacement of the ascending aorta with reduction of the diameter of the sinotubular junction to treat aortic insufficiency in patients with ascending aortic aneurysm. J Thorac Cardiovasc Surg 2007;133:414-8. https://doi.org/10.1016/j.jtcvs.2006.09.049
  9. Matalanis G, Shi WY, Hayward PA. Correction of leaflet prolapse extends the spectrum of patients suitable for valvesparing aortic root replacement. Eur J Cardiothorac Surg 2010;37:1311-6. https://doi.org/10.1016/j.ejcts.2009.12.031
  10. de Kerchove L, Boodhwani M, Glineur D, et al. Effects of preoperative aortic insufficiency on outcome after aortic valve-sparing surgery. Circulation 2009;120(11 Suppl):S120-6
  11. Badiu CC, Eichinger W, Bleiziffer S, et al. Should root replacement with aortic valve-sparing be offered to patients with bicuspid valves or severe aortic regurgitation? Eur J Cardiothorac Surg 2010;38:515-22. https://doi.org/10.1016/j.ejcts.2010.03.005
  12. Kerendi F, Guyton RA, Vega JD, Kilgo PD, Chen EP. Early results of valve-sparing aortic root replacement in high-risk clinical scenarios. Ann Thorac Surg 2010;89:471-6. https://doi.org/10.1016/j.athoracsur.2009.10.030
  13. Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: the Euro Heart Survey on Valvular Heart Disease. Eur Heart J 2003; 24:1231-43. https://doi.org/10.1016/S0195-668X(03)00201-X
  14. Lansac E, Di Centa I, Raoux F, et al. A lesional classification to standardize surgical management of aortic insufficiency towards valve repair. Eur J Cardiothorac Surg 2008;33:872-8. https://doi.org/10.1016/j.ejcts.2007.12.033
  15. Gleason TG. Current perspective on aortic valve repair and valve-sparing aortic root replacement. Semin Thorac Cardiovasc Surg 2006;18:154-64. https://doi.org/10.1053/j.semtcvs.2006.07.005
  16. Patel ND, Weiss ES, Alejo DE, et al. Aortic root operations for Marfan syndrome: a comparison of the Bentall and valve-sparing procedures. Ann Thorac Surg 2008;85:2003-10 https://doi.org/10.1016/j.athoracsur.2008.01.032
  17. Gott VL, Greene PS, Alejo DE, et al. Replacement of the aortic root in patients with Marfan's syndrome. N Engl J Med 1999;340:1307-13. https://doi.org/10.1056/NEJM199904293401702
  18. Gelsomino S, Morocutti G, Frassani R, et al. Long-term results of Bentall composite aortic root replacement for ascending aortic aneurysms and dissections. Chest 2003;124: 984-8. https://doi.org/10.1378/chest.124.3.984

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