Contemporary Etiologies, Mechanisms, and Surgical Approaches in Pure Native Aortic Regurgitation

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Abstract

Objective: To study contemporary etiologies, mechanisms, and corresponding surgical approaches in isolated aortic regurgitation (AR). Patients and Methods: Consecutive patients undergoing surgery for moderately severe and severe AR were retrospectively identified from January 1, 2006, through October 20, 2017. Intraoperative echocardiograms, surgical reports, and pathology reports were reviewed. Results: Of 382 patients (54±16 years, 82% men), there were 207 (54%) tricuspid (TAV), 167 (44%) bicuspid (BAV), 5 quadricuspid, and 3 unicuspid aortic valves. Isolated AR mechanisms (n=116, 30%) included cusp prolapse (n=44, 11%), restriction/retraction (n=33, 9%), aortic root dilatation (n=33, 9%), perforation (n=5, 1%), and fenestration (<1%); mixed mechanisms were present in 266 (70%). The most common mixed mechanism was root dilatation and prolapse (27% BAV vs 16% TAV, P=.01). Valve repair (AVr) was performed in 31% BAV and 23% TAV (P=.06). Aortic surgery was more common in BAV (37% vs 27%, P<.001). Overall, root dilatation was associated with AVr. In TAV, cusp prolapse and restriction/retraction were associated with replacement; in BAV, prolapse was associated with AVr. AR etiology was idiopathic in 43% TAV patients, 47% of whom had root dilatation. Conclusions: BAV accounted for 44% of surgical referrals for AR and, compared with TAV, was more often associated with prolapse, root dilatation, and mixed mechanisms of AR. Because mechanisms affected the choice of AVr differently in BAV and TAV, comprehensive mechanistic description of surgical AR is critical.

Original languageEnglish (US)
Pages (from-to)1158-1170
Number of pages13
JournalMayo Clinic proceedings
Volume94
Issue number7
DOIs
StatePublished - Jul 1 2019

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Aortic Valve Insufficiency
Prolapse
Dilatation
Surgical Pathology
Bicuspid
Aortic Valve
Referral and Consultation

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{36142ca790a744daa5664a75df90463e,
title = "Contemporary Etiologies, Mechanisms, and Surgical Approaches in Pure Native Aortic Regurgitation",
abstract = "Objective: To study contemporary etiologies, mechanisms, and corresponding surgical approaches in isolated aortic regurgitation (AR). Patients and Methods: Consecutive patients undergoing surgery for moderately severe and severe AR were retrospectively identified from January 1, 2006, through October 20, 2017. Intraoperative echocardiograms, surgical reports, and pathology reports were reviewed. Results: Of 382 patients (54±16 years, 82{\%} men), there were 207 (54{\%}) tricuspid (TAV), 167 (44{\%}) bicuspid (BAV), 5 quadricuspid, and 3 unicuspid aortic valves. Isolated AR mechanisms (n=116, 30{\%}) included cusp prolapse (n=44, 11{\%}), restriction/retraction (n=33, 9{\%}), aortic root dilatation (n=33, 9{\%}), perforation (n=5, 1{\%}), and fenestration (<1{\%}); mixed mechanisms were present in 266 (70{\%}). The most common mixed mechanism was root dilatation and prolapse (27{\%} BAV vs 16{\%} TAV, P=.01). Valve repair (AVr) was performed in 31{\%} BAV and 23{\%} TAV (P=.06). Aortic surgery was more common in BAV (37{\%} vs 27{\%}, P<.001). Overall, root dilatation was associated with AVr. In TAV, cusp prolapse and restriction/retraction were associated with replacement; in BAV, prolapse was associated with AVr. AR etiology was idiopathic in 43{\%} TAV patients, 47{\%} of whom had root dilatation. Conclusions: BAV accounted for 44{\%} of surgical referrals for AR and, compared with TAV, was more often associated with prolapse, root dilatation, and mixed mechanisms of AR. Because mechanisms affected the choice of AVr differently in BAV and TAV, comprehensive mechanistic description of surgical AR is critical.",
author = "Yang, {Li Tan} and Michelena, {Hector I} and Joseph Maleszewski and Schaff, {Hartzell V} and Patricia Pellikka",
year = "2019",
month = "7",
day = "1",
doi = "10.1016/j.mayocp.2018.11.034",
language = "English (US)",
volume = "94",
pages = "1158--1170",
journal = "Mayo Clinic Proceedings",
issn = "0025-6196",
publisher = "Elsevier Science",
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TY - JOUR

T1 - Contemporary Etiologies, Mechanisms, and Surgical Approaches in Pure Native Aortic Regurgitation

AU - Yang, Li Tan

AU - Michelena, Hector I

AU - Maleszewski, Joseph

AU - Schaff, Hartzell V

AU - Pellikka, Patricia

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Objective: To study contemporary etiologies, mechanisms, and corresponding surgical approaches in isolated aortic regurgitation (AR). Patients and Methods: Consecutive patients undergoing surgery for moderately severe and severe AR were retrospectively identified from January 1, 2006, through October 20, 2017. Intraoperative echocardiograms, surgical reports, and pathology reports were reviewed. Results: Of 382 patients (54±16 years, 82% men), there were 207 (54%) tricuspid (TAV), 167 (44%) bicuspid (BAV), 5 quadricuspid, and 3 unicuspid aortic valves. Isolated AR mechanisms (n=116, 30%) included cusp prolapse (n=44, 11%), restriction/retraction (n=33, 9%), aortic root dilatation (n=33, 9%), perforation (n=5, 1%), and fenestration (<1%); mixed mechanisms were present in 266 (70%). The most common mixed mechanism was root dilatation and prolapse (27% BAV vs 16% TAV, P=.01). Valve repair (AVr) was performed in 31% BAV and 23% TAV (P=.06). Aortic surgery was more common in BAV (37% vs 27%, P<.001). Overall, root dilatation was associated with AVr. In TAV, cusp prolapse and restriction/retraction were associated with replacement; in BAV, prolapse was associated with AVr. AR etiology was idiopathic in 43% TAV patients, 47% of whom had root dilatation. Conclusions: BAV accounted for 44% of surgical referrals for AR and, compared with TAV, was more often associated with prolapse, root dilatation, and mixed mechanisms of AR. Because mechanisms affected the choice of AVr differently in BAV and TAV, comprehensive mechanistic description of surgical AR is critical.

AB - Objective: To study contemporary etiologies, mechanisms, and corresponding surgical approaches in isolated aortic regurgitation (AR). Patients and Methods: Consecutive patients undergoing surgery for moderately severe and severe AR were retrospectively identified from January 1, 2006, through October 20, 2017. Intraoperative echocardiograms, surgical reports, and pathology reports were reviewed. Results: Of 382 patients (54±16 years, 82% men), there were 207 (54%) tricuspid (TAV), 167 (44%) bicuspid (BAV), 5 quadricuspid, and 3 unicuspid aortic valves. Isolated AR mechanisms (n=116, 30%) included cusp prolapse (n=44, 11%), restriction/retraction (n=33, 9%), aortic root dilatation (n=33, 9%), perforation (n=5, 1%), and fenestration (<1%); mixed mechanisms were present in 266 (70%). The most common mixed mechanism was root dilatation and prolapse (27% BAV vs 16% TAV, P=.01). Valve repair (AVr) was performed in 31% BAV and 23% TAV (P=.06). Aortic surgery was more common in BAV (37% vs 27%, P<.001). Overall, root dilatation was associated with AVr. In TAV, cusp prolapse and restriction/retraction were associated with replacement; in BAV, prolapse was associated with AVr. AR etiology was idiopathic in 43% TAV patients, 47% of whom had root dilatation. Conclusions: BAV accounted for 44% of surgical referrals for AR and, compared with TAV, was more often associated with prolapse, root dilatation, and mixed mechanisms of AR. Because mechanisms affected the choice of AVr differently in BAV and TAV, comprehensive mechanistic description of surgical AR is critical.

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U2 - 10.1016/j.mayocp.2018.11.034

DO - 10.1016/j.mayocp.2018.11.034

M3 - Article

VL - 94

SP - 1158

EP - 1170

JO - Mayo Clinic Proceedings

JF - Mayo Clinic Proceedings

SN - 0025-6196

IS - 7

ER -