Expanding relevance of aortic valve repair - Is earlier operation indicated?

Vikas Sharma, Rakesh M. Suri, Joseph A. Dearani, Harold M. Burkhart, Soon J. Park, Lyle D. Joyce, Zhuo Li, Hartzell V Schaff

Research output: Contribution to journalArticle

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Abstract

Objectives: To define the durability of aortic valve repair (AVR ep) and the effect of surgical timing on late survival. Methods: From June 1986 to June 2011, 331 patients underwent elective AVRep for aortic regurgitation (mean age, 53 ± 17 years; 76% men). The repair methods included commissuroplasty (n = 270; 81%), triangular resection and plication (n = 106; 32%), resuspension or cusp shortening (n = 102; 31%), and perforation closure (n = 23; 7%). Results: In-hospital mortality was 0.6% (2 of 332). Four patients (1%) experienced early repair failure; two underwent repeat repair. Overall survival was 91% and 81% at 5 and 10 years, respectively. After adjusting for age, greater left ventricular end-systolic dimension (per 5 mm; hazard ratio [HR], 1.49; 95% confidence interval [CI], 1.23-1.79; P <.001) and lower ejection fraction (per 5%; HR, 1.42; 95% CI, 1.25-1.63; P ≤.001) were significant predictors of long-term mortality. Patients with ejection fraction < 50% and left ventricular end-systolic dimension > 50 mm had significantly greater odds of late death (HR, 3.46; 95% CI, 2.05-5.82; P <.001 and HR, 2.08; 95% CI, 1.05-4.12; P =.036, respectively). The risk of aortic valve reoperation was 10% and 21% at 5 and 10 years, respectively. The presence of severe aortic regurgitation (HR, 2.2; 95% CI, 1.1-5.06; P =.02) and more than mild regurgitation at discharge (HR, 5.87; 95% CI, 2.67-12.68; P ≤.0001) were predictors of late reoperation. Freedom from other valve-related events was 94% and 91% at 5 and 10 years, respectively. Forty-seven patients (21%) with intact valve repair were using warfarin at the last follow-up visit. Conclusions: AVRep can be performed with excellent late survival and freedom from valve-related events. Awaiting the onset of ventricular dysfunction increases the risk of late mortality, warranting earlier consideration of AVRep for patients with suitable anatomy.

Original languageEnglish (US)
Pages (from-to)100-108
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume147
Issue number1
DOIs
StatePublished - Jan 2014

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Aortic Valve
Confidence Intervals
Aortic Valve Insufficiency
Reoperation
Survival
Ventricular Dysfunction
Warfarin
Hospital Mortality
Anatomy
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Expanding relevance of aortic valve repair - Is earlier operation indicated? / Sharma, Vikas; Suri, Rakesh M.; Dearani, Joseph A.; Burkhart, Harold M.; Park, Soon J.; Joyce, Lyle D.; Li, Zhuo; Schaff, Hartzell V.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 147, No. 1, 01.2014, p. 100-108.

Research output: Contribution to journalArticle

Sharma, Vikas ; Suri, Rakesh M. ; Dearani, Joseph A. ; Burkhart, Harold M. ; Park, Soon J. ; Joyce, Lyle D. ; Li, Zhuo ; Schaff, Hartzell V. / Expanding relevance of aortic valve repair - Is earlier operation indicated?. In: Journal of Thoracic and Cardiovascular Surgery. 2014 ; Vol. 147, No. 1. pp. 100-108.
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abstract = "Objectives: To define the durability of aortic valve repair (AVR ep) and the effect of surgical timing on late survival. Methods: From June 1986 to June 2011, 331 patients underwent elective AVRep for aortic regurgitation (mean age, 53 ± 17 years; 76{\%} men). The repair methods included commissuroplasty (n = 270; 81{\%}), triangular resection and plication (n = 106; 32{\%}), resuspension or cusp shortening (n = 102; 31{\%}), and perforation closure (n = 23; 7{\%}). Results: In-hospital mortality was 0.6{\%} (2 of 332). Four patients (1{\%}) experienced early repair failure; two underwent repeat repair. Overall survival was 91{\%} and 81{\%} at 5 and 10 years, respectively. After adjusting for age, greater left ventricular end-systolic dimension (per 5 mm; hazard ratio [HR], 1.49; 95{\%} confidence interval [CI], 1.23-1.79; P <.001) and lower ejection fraction (per 5{\%}; HR, 1.42; 95{\%} CI, 1.25-1.63; P ≤.001) were significant predictors of long-term mortality. Patients with ejection fraction < 50{\%} and left ventricular end-systolic dimension > 50 mm had significantly greater odds of late death (HR, 3.46; 95{\%} CI, 2.05-5.82; P <.001 and HR, 2.08; 95{\%} CI, 1.05-4.12; P =.036, respectively). The risk of aortic valve reoperation was 10{\%} and 21{\%} at 5 and 10 years, respectively. The presence of severe aortic regurgitation (HR, 2.2; 95{\%} CI, 1.1-5.06; P =.02) and more than mild regurgitation at discharge (HR, 5.87; 95{\%} CI, 2.67-12.68; P ≤.0001) were predictors of late reoperation. Freedom from other valve-related events was 94{\%} and 91{\%} at 5 and 10 years, respectively. Forty-seven patients (21{\%}) with intact valve repair were using warfarin at the last follow-up visit. Conclusions: AVRep can be performed with excellent late survival and freedom from valve-related events. Awaiting the onset of ventricular dysfunction increases the risk of late mortality, warranting earlier consideration of AVRep for patients with suitable anatomy.",
author = "Vikas Sharma and Suri, {Rakesh M.} and Dearani, {Joseph A.} and Burkhart, {Harold M.} and Park, {Soon J.} and Joyce, {Lyle D.} and Zhuo Li and Schaff, {Hartzell V}",
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T1 - Expanding relevance of aortic valve repair - Is earlier operation indicated?

AU - Sharma, Vikas

AU - Suri, Rakesh M.

AU - Dearani, Joseph A.

AU - Burkhart, Harold M.

AU - Park, Soon J.

AU - Joyce, Lyle D.

AU - Li, Zhuo

AU - Schaff, Hartzell V

PY - 2014/1

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N2 - Objectives: To define the durability of aortic valve repair (AVR ep) and the effect of surgical timing on late survival. Methods: From June 1986 to June 2011, 331 patients underwent elective AVRep for aortic regurgitation (mean age, 53 ± 17 years; 76% men). The repair methods included commissuroplasty (n = 270; 81%), triangular resection and plication (n = 106; 32%), resuspension or cusp shortening (n = 102; 31%), and perforation closure (n = 23; 7%). Results: In-hospital mortality was 0.6% (2 of 332). Four patients (1%) experienced early repair failure; two underwent repeat repair. Overall survival was 91% and 81% at 5 and 10 years, respectively. After adjusting for age, greater left ventricular end-systolic dimension (per 5 mm; hazard ratio [HR], 1.49; 95% confidence interval [CI], 1.23-1.79; P <.001) and lower ejection fraction (per 5%; HR, 1.42; 95% CI, 1.25-1.63; P ≤.001) were significant predictors of long-term mortality. Patients with ejection fraction < 50% and left ventricular end-systolic dimension > 50 mm had significantly greater odds of late death (HR, 3.46; 95% CI, 2.05-5.82; P <.001 and HR, 2.08; 95% CI, 1.05-4.12; P =.036, respectively). The risk of aortic valve reoperation was 10% and 21% at 5 and 10 years, respectively. The presence of severe aortic regurgitation (HR, 2.2; 95% CI, 1.1-5.06; P =.02) and more than mild regurgitation at discharge (HR, 5.87; 95% CI, 2.67-12.68; P ≤.0001) were predictors of late reoperation. Freedom from other valve-related events was 94% and 91% at 5 and 10 years, respectively. Forty-seven patients (21%) with intact valve repair were using warfarin at the last follow-up visit. Conclusions: AVRep can be performed with excellent late survival and freedom from valve-related events. Awaiting the onset of ventricular dysfunction increases the risk of late mortality, warranting earlier consideration of AVRep for patients with suitable anatomy.

AB - Objectives: To define the durability of aortic valve repair (AVR ep) and the effect of surgical timing on late survival. Methods: From June 1986 to June 2011, 331 patients underwent elective AVRep for aortic regurgitation (mean age, 53 ± 17 years; 76% men). The repair methods included commissuroplasty (n = 270; 81%), triangular resection and plication (n = 106; 32%), resuspension or cusp shortening (n = 102; 31%), and perforation closure (n = 23; 7%). Results: In-hospital mortality was 0.6% (2 of 332). Four patients (1%) experienced early repair failure; two underwent repeat repair. Overall survival was 91% and 81% at 5 and 10 years, respectively. After adjusting for age, greater left ventricular end-systolic dimension (per 5 mm; hazard ratio [HR], 1.49; 95% confidence interval [CI], 1.23-1.79; P <.001) and lower ejection fraction (per 5%; HR, 1.42; 95% CI, 1.25-1.63; P ≤.001) were significant predictors of long-term mortality. Patients with ejection fraction < 50% and left ventricular end-systolic dimension > 50 mm had significantly greater odds of late death (HR, 3.46; 95% CI, 2.05-5.82; P <.001 and HR, 2.08; 95% CI, 1.05-4.12; P =.036, respectively). The risk of aortic valve reoperation was 10% and 21% at 5 and 10 years, respectively. The presence of severe aortic regurgitation (HR, 2.2; 95% CI, 1.1-5.06; P =.02) and more than mild regurgitation at discharge (HR, 5.87; 95% CI, 2.67-12.68; P ≤.0001) were predictors of late reoperation. Freedom from other valve-related events was 94% and 91% at 5 and 10 years, respectively. Forty-seven patients (21%) with intact valve repair were using warfarin at the last follow-up visit. Conclusions: AVRep can be performed with excellent late survival and freedom from valve-related events. Awaiting the onset of ventricular dysfunction increases the risk of late mortality, warranting earlier consideration of AVRep for patients with suitable anatomy.

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