Is repair of aortic valve regurgitation a safe alternative to valve replacement?

Kenji Minakata, Hartzell V Schaff, Kenton J. Zehr, Joseph A. Dearani, Richard C. Daly, Thomas A. Orszulak, Francisco J. Puga, Gordon K. Danielson, Lawrence H. Cohn, Robert A. Dion, Christophe Acar, A. Sampath Kumar

Research output: Contribution to journalArticle

87 Citations (Scopus)

Abstract

Objective: To assess outcome of valve repair in patients with aortic valve regurgitation with emphasis on incidence and risk of reoperation. Methods: We retrospectively reviewed 160 consecutive patients (127 men) who underwent aortic valve repair between 1986 and 2001. Ages ranged from 14 to 84 years (mean 55 ± 17 years). Patients were categorized according to the main etiology of valve disease; 63 patients (39%) had annular dilation leading to central leakage, 54 (34%) had bicuspid valve, 34 (21%) with tricuspid valve had cusp prolapse, and 9 (6%) had cusp perforation. Repair methods included commissural plication (n = 154, 96%), partial cusp resection with plication (n = 47, 29%), resuspension or cusp shortening (n = 44, 28%), and closure of cusp perforation (n = 10, 6%). Results: There was 1 early death (0.6%). Two patients required re-repair of the aortic valve during initial hospitalization. During a mean follow-up of 4.2 years, there were 16 late deaths. Overall, 16 of 159 hospital survivors had late reoperation on the aortic valve (mean interval 2.8 years) without early mortality. Risks of reoperation on the aortic valve were 9%, 11%, and 15% at 3, 5, and 7 years, respectively. Conclusions: Aortic valve repair can be performed with low risk and excellent freedom from valve-related morbidity and mortality. Late recurrence of aortic valve regurgitation led to reoperation in 8.8% of patients, but mortality associated with subsequent procedures is low. Aortic valve repair appears to be a good option for selected patients, particularly young patients who wish to avoid chronic anticoagulation with warfarin.

Original languageEnglish (US)
Pages (from-to)645-653
Number of pages9
JournalJournal of Thoracic and Cardiovascular Surgery
Volume127
Issue number3
DOIs
StatePublished - Mar 2004

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Aortic Valve Insufficiency
Aortic Valve
Reoperation
Mortality
Tricuspid Valve
Prolapse
Warfarin
Mitral Valve
Survivors
Dilatation
Hospitalization
Morbidity
Recurrence
Incidence

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Is repair of aortic valve regurgitation a safe alternative to valve replacement? / Minakata, Kenji; Schaff, Hartzell V; Zehr, Kenton J.; Dearani, Joseph A.; Daly, Richard C.; Orszulak, Thomas A.; Puga, Francisco J.; Danielson, Gordon K.; Cohn, Lawrence H.; Dion, Robert A.; Acar, Christophe; Kumar, A. Sampath.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 127, No. 3, 03.2004, p. 645-653.

Research output: Contribution to journalArticle

Minakata, K, Schaff, HV, Zehr, KJ, Dearani, JA, Daly, RC, Orszulak, TA, Puga, FJ, Danielson, GK, Cohn, LH, Dion, RA, Acar, C & Kumar, AS 2004, 'Is repair of aortic valve regurgitation a safe alternative to valve replacement?', Journal of Thoracic and Cardiovascular Surgery, vol. 127, no. 3, pp. 645-653. https://doi.org/10.1016/j.jtcvs.2003.09.018
Minakata, Kenji ; Schaff, Hartzell V ; Zehr, Kenton J. ; Dearani, Joseph A. ; Daly, Richard C. ; Orszulak, Thomas A. ; Puga, Francisco J. ; Danielson, Gordon K. ; Cohn, Lawrence H. ; Dion, Robert A. ; Acar, Christophe ; Kumar, A. Sampath. / Is repair of aortic valve regurgitation a safe alternative to valve replacement?. In: Journal of Thoracic and Cardiovascular Surgery. 2004 ; Vol. 127, No. 3. pp. 645-653.
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abstract = "Objective: To assess outcome of valve repair in patients with aortic valve regurgitation with emphasis on incidence and risk of reoperation. Methods: We retrospectively reviewed 160 consecutive patients (127 men) who underwent aortic valve repair between 1986 and 2001. Ages ranged from 14 to 84 years (mean 55 ± 17 years). Patients were categorized according to the main etiology of valve disease; 63 patients (39{\%}) had annular dilation leading to central leakage, 54 (34{\%}) had bicuspid valve, 34 (21{\%}) with tricuspid valve had cusp prolapse, and 9 (6{\%}) had cusp perforation. Repair methods included commissural plication (n = 154, 96{\%}), partial cusp resection with plication (n = 47, 29{\%}), resuspension or cusp shortening (n = 44, 28{\%}), and closure of cusp perforation (n = 10, 6{\%}). Results: There was 1 early death (0.6{\%}). Two patients required re-repair of the aortic valve during initial hospitalization. During a mean follow-up of 4.2 years, there were 16 late deaths. Overall, 16 of 159 hospital survivors had late reoperation on the aortic valve (mean interval 2.8 years) without early mortality. Risks of reoperation on the aortic valve were 9{\%}, 11{\%}, and 15{\%} at 3, 5, and 7 years, respectively. Conclusions: Aortic valve repair can be performed with low risk and excellent freedom from valve-related morbidity and mortality. Late recurrence of aortic valve regurgitation led to reoperation in 8.8{\%} of patients, but mortality associated with subsequent procedures is low. Aortic valve repair appears to be a good option for selected patients, particularly young patients who wish to avoid chronic anticoagulation with warfarin.",
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T1 - Is repair of aortic valve regurgitation a safe alternative to valve replacement?

AU - Minakata, Kenji

AU - Schaff, Hartzell V

AU - Zehr, Kenton J.

AU - Dearani, Joseph A.

AU - Daly, Richard C.

AU - Orszulak, Thomas A.

AU - Puga, Francisco J.

AU - Danielson, Gordon K.

AU - Cohn, Lawrence H.

AU - Dion, Robert A.

AU - Acar, Christophe

AU - Kumar, A. Sampath

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Y1 - 2004/3

N2 - Objective: To assess outcome of valve repair in patients with aortic valve regurgitation with emphasis on incidence and risk of reoperation. Methods: We retrospectively reviewed 160 consecutive patients (127 men) who underwent aortic valve repair between 1986 and 2001. Ages ranged from 14 to 84 years (mean 55 ± 17 years). Patients were categorized according to the main etiology of valve disease; 63 patients (39%) had annular dilation leading to central leakage, 54 (34%) had bicuspid valve, 34 (21%) with tricuspid valve had cusp prolapse, and 9 (6%) had cusp perforation. Repair methods included commissural plication (n = 154, 96%), partial cusp resection with plication (n = 47, 29%), resuspension or cusp shortening (n = 44, 28%), and closure of cusp perforation (n = 10, 6%). Results: There was 1 early death (0.6%). Two patients required re-repair of the aortic valve during initial hospitalization. During a mean follow-up of 4.2 years, there were 16 late deaths. Overall, 16 of 159 hospital survivors had late reoperation on the aortic valve (mean interval 2.8 years) without early mortality. Risks of reoperation on the aortic valve were 9%, 11%, and 15% at 3, 5, and 7 years, respectively. Conclusions: Aortic valve repair can be performed with low risk and excellent freedom from valve-related morbidity and mortality. Late recurrence of aortic valve regurgitation led to reoperation in 8.8% of patients, but mortality associated with subsequent procedures is low. Aortic valve repair appears to be a good option for selected patients, particularly young patients who wish to avoid chronic anticoagulation with warfarin.

AB - Objective: To assess outcome of valve repair in patients with aortic valve regurgitation with emphasis on incidence and risk of reoperation. Methods: We retrospectively reviewed 160 consecutive patients (127 men) who underwent aortic valve repair between 1986 and 2001. Ages ranged from 14 to 84 years (mean 55 ± 17 years). Patients were categorized according to the main etiology of valve disease; 63 patients (39%) had annular dilation leading to central leakage, 54 (34%) had bicuspid valve, 34 (21%) with tricuspid valve had cusp prolapse, and 9 (6%) had cusp perforation. Repair methods included commissural plication (n = 154, 96%), partial cusp resection with plication (n = 47, 29%), resuspension or cusp shortening (n = 44, 28%), and closure of cusp perforation (n = 10, 6%). Results: There was 1 early death (0.6%). Two patients required re-repair of the aortic valve during initial hospitalization. During a mean follow-up of 4.2 years, there were 16 late deaths. Overall, 16 of 159 hospital survivors had late reoperation on the aortic valve (mean interval 2.8 years) without early mortality. Risks of reoperation on the aortic valve were 9%, 11%, and 15% at 3, 5, and 7 years, respectively. Conclusions: Aortic valve repair can be performed with low risk and excellent freedom from valve-related morbidity and mortality. Late recurrence of aortic valve regurgitation led to reoperation in 8.8% of patients, but mortality associated with subsequent procedures is low. Aortic valve repair appears to be a good option for selected patients, particularly young patients who wish to avoid chronic anticoagulation with warfarin.

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