Severity of Preoperative Aortic Regurgitation Does Not Impact Valve Durability of Aortic Valve Repair Following the David V Valve Sparing Aortic Root Replacement.
BACKGROUND
The David V valve-sparing aortic root replacement (VSRR) is an established and durable method of root reconstruction for varying pathologies. However, the impact of the severity of preoperative aortic regurgitation (AR) on long-term durability remains unclear. The purpose of this research was to investigate the impact of the degree of preoperative AR on midterm durability following VSRR.


METHODS
A retrospective review of the adult cardiac surgical database at a single academic center was undertaken from 2005 to 2015 for 223 adult patients who underwent VSRR. Patients were followed annually with echocardiograms, and a prospectively maintained database kept track of patient data. Follow-up was 97.7% complete, and the median echocardiographic follow-up was 25.5 months (range, 1 to 123 months). Patients with preoperative AR less than or equal to 2 were compared with patients with AR greater than 2 to determine the impact of preoperative AR upon valve repair durability.


RESULTS
There were 223 patients who underwent VSRR during the study period, including 114 (51.1%) who required concomitant cusp repair. The operative mortality was 5 (2.2%). Ninety-seven patients (43.5%) had preoperative AR greater than 2. A total of 213 patients (95.5%) were available for long-term follow-up; of these patients, 7 (3.3%) had AR greater than 2. Fifty-two patients had a bicuspid aortic valve (22 AR ≤2 and 30 AR >2; p = 0.02). Patients with preoperative AR greater than 2 experienced greater reverse left ventricular remodeling and increases in left ventricular ejection fraction than did patients with preoperative AR less than or equal to 2 (p < 0.01). The midterm freedom from AR greater than 2 was similar for both preoperative AR groups (p = 0.57). The 8-year freedom from AR greater than 2 was 89.1% (95% confidence interval, 55.3% to 97.8%) for patients with preoperative AR less than or equal to 2 and 92.7% (95% confidence interval, 78.8% to 97.6%) for preoperative AR greater than 2. Five patients (2.4%) required aortic valve replacement during the follow-up period (3 preoperative AR ≤2, 2 preoperative AR >2).


CONCLUSIONS
VSRR remains an effective and durable treatment for severe AR and preserved leaflet architecture. The severity of preoperative AR does not appear to impact midterm freedom from moderate to severe AR. VSRR results in significant left ventricular remodeling in patients with preoperative AR greater than 2.
Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia. Electronic address: brent.keeling@emory.edu.
W Brent
WB
Keeling
Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia.
Bradley G
BG
Leshnower
Rollins School of Public Health, Emory University, Atlanta, Georgia.
Jose
J
Binongo
Rollins School of Public Health, Emory University, Atlanta, Georgia.
Yi
Y
Lasanajak
Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia.
LaRonica
L
McPherson
Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia.
Edward P
EP
Chen
D000368:Aged; D001022:Aortic Valve Insufficiency / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D020257:Ventricular Remodeling