title: Surgical treatment of aortic regurgitation due to Takayasu arteritis: long-term morbidity and mortality.
abstract: 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.
authors.affiliation: Department of Cardiovascular Surgery, National Cardiovascular Center, Suita, Osaka, Japan.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Matsuura
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ogino
authors.forename: Junjiro
authors.initials: J
authors.lastname: Kobayashi
authors.forename: Hatsue
authors.initials: H
authors.lastname: Ishibashi-Ueda
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Matsuda
authors.forename: Kenji
authors.initials: K
authors.lastname: Minatoya
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sasaki
authors.forename: Ko
authors.initials: K
authors.lastname: Bando
authors.forename: Kazuo
authors.initials: K
authors.lastname: Niwaya
authors.forename: Osamu
authors.initials: O
authors.lastname: Tagusari
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakajima
authors.forename: Toshikatsu
authors.initials: T
authors.lastname: Yagihara
authors.forename: Soichiro
authors.initials: S
authors.lastname: Kitamura
mesh_terms: 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
chemical_list: D013256:Steroids