Surgical treatment of aortic regurgitation due to Takayasu arteritis: long-term morbidity and mortality.
BACKGROUND
The goal of this retrospective study was to determine the late outcome of surgical treatment for aortic valve regurgitation due to Takayasu arteritis and correlate it with evidence of inflammation on pathological examination.


RESULTS
Ninety consecutive patients who underwent surgery for aortic valve regurgitation due to Takayasu arteritis between 1979 and 2003 were studied. Intraoperative pathological specimens of the aortic wall from 69 patients were retrospectively examined for inflammation. Aortic valve replacement was performed in 63 patients (group A) and composite graft repair in 27 patients (group B). The aortic root diameter was 39.9+/-9.5 mm in group A and 54.4+/-13.6 mm in group B (P<0.0001). Preoperative steroid therapy was performed in 40 patients (44.4%). Hospital mortality was 4.8% (3/63) in group A and 7.4% (2/27) in group B. The overall 15-year survival rate was 76.1%. Detachment of the valve or graft occurred in 11.1% (7/63) of group A and in 3.7% (1/27) of group B patients (P=0.43). Late dilatation (>50 mm) of the residual ascending aorta occurred in 11.1% (7/63) of group A and in 3.7% (1/27) of group B patients (P=0.43). Active inflammation was confirmed in intraoperative pathological specimens of 10 patients, and detachment of the valve or graft occurred in 4 of these patients. Univariate analysis of background variables revealed active inflammation to be a risk factor for detachment (P=0.0001; risk ratio 55).


CONCLUSIONS
Late dilatation of the ascending aorta after aortic valve replacement is a clinically important finding. Active inflammation could be related to valve or graft detachment.
Matsuura
Kaoru
K
Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka, Japan.
Ogino
Hitoshi
H
Kobayashi
Junjiro
J
Ishibashi-Ueda
Hatsue
H
Matsuda
Hitoshi
H
Minatoya
Kenji
K
Sasaki
Hiroaki
H
Bando
Ko
K
Niwaya
Kazuo
K
Tagusari
Osamu
O
Nakajima
Hiroyuki
H
Yagihara
Toshikatsu
T
Kitamura
Soichiro
S
D000328:Adult; D001021:Aortic Valve / Q000473:pathology; D001022:Aortic Valve Insufficiency / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011475:Prosthesis Failure; D012189:Retrospective Studies; D012307:Risk Factors; D013256:Steroids / Q000627:therapeutic use; D016019:Survival Analysis; D013625:Takayasu Arteritis / Q000150:complications* / Q000401:mortality / Q000473:pathology; D016896:Treatment Outcome
D013256:Steroids