Predictors of paravalvular aortic regurgitation after surgery for Behcet's disease-related severe aortic regurgitation

Hong Mi Choi, Hyung Kwan Kim, Sung Ji Park, Hyun Jung Lee, Yeonyee E. Yoon, Jun Bean Park, Yong Jin Kim, Goo Young Cho, In Chang Hwang, Dae Won Sohn, Jae Kuen Oh

Research output: Contribution to journalArticle

Abstract

Background: Behcet's disease (BD)-related aortic regurgitation (AR) is known to be associated with paravalvular leakage (PVL) after successful aortic valve (AV) surgery. This study aimed to determine predictors of PVL after successful AV surgery in BD patients. We retrospectively collected data of 35 patients (42.1 ± 9.1 years, 27 men) who underwent surgery for severe BD-related AR at two tertiary centers. The diagnosis was established based on echocardiographic, surgical, and/or pathological findings in conjunction with the International Study Group criteria for BD. A total of 76 cases of AV surgery in 35 patients were analyzed. Results: A median follow-up duration was 8.0 years (interquartile range, 5.4-14.3 years). PVL developed in 18 patients (51.4%) within 2 years after the first surgery. Six patients who met the diagnostic criteria for BD did not develop PVL, in whom 5 patients took immunosuppressive therapy (IST). However, 4 of 9 patients (44.4%) who did not meet the diagnostic criteria developed PVL, in whom four (44.4%) patients took IST. On multivariable analysis, postoperative IST and concomitant aortic root replacement (ARR) were two independent predictors for less PVL development (HR 0.38, 95% CI 0.17-0.89, p = 0.025 for postoperative IST; HR 0.17, 95% CI 0.08-0.36, p < 0.001 for concomitant ARR). Preoperative IST use did not determine PVL development (p = 0.75). Conclusions: Postoperative, but not preoperative, IST and concomitant ARR were independent predictors of less development of PVL. Special attention is required for early diagnosis BD-related AR, especially in patients not satisfying the current diagnostic criteria.

Original languageEnglish (US)
Article number132
JournalOrphanet Journal of Rare Diseases
Volume14
Issue number1
DOIs
StatePublished - Jun 10 2019

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Aortic Valve Insufficiency
Behcet Syndrome
Immunosuppressive Agents
Aortic Valve
Therapeutics
Early Diagnosis

Keywords

  • Aortic regurgitation
  • Aortic valve surgery
  • Behcet's disease
  • Paravalvular leakage

ASJC Scopus subject areas

  • Genetics(clinical)
  • Pharmacology (medical)

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Predictors of paravalvular aortic regurgitation after surgery for Behcet's disease-related severe aortic regurgitation. / Choi, Hong Mi; Kim, Hyung Kwan; Park, Sung Ji; Lee, Hyun Jung; Yoon, Yeonyee E.; Park, Jun Bean; Kim, Yong Jin; Cho, Goo Young; Hwang, In Chang; Sohn, Dae Won; Oh, Jae Kuen.

In: Orphanet Journal of Rare Diseases, Vol. 14, No. 1, 132, 10.06.2019.

Research output: Contribution to journalArticle

Choi, Hong Mi ; Kim, Hyung Kwan ; Park, Sung Ji ; Lee, Hyun Jung ; Yoon, Yeonyee E. ; Park, Jun Bean ; Kim, Yong Jin ; Cho, Goo Young ; Hwang, In Chang ; Sohn, Dae Won ; Oh, Jae Kuen. / Predictors of paravalvular aortic regurgitation after surgery for Behcet's disease-related severe aortic regurgitation. In: Orphanet Journal of Rare Diseases. 2019 ; Vol. 14, No. 1.
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abstract = "Background: Behcet's disease (BD)-related aortic regurgitation (AR) is known to be associated with paravalvular leakage (PVL) after successful aortic valve (AV) surgery. This study aimed to determine predictors of PVL after successful AV surgery in BD patients. We retrospectively collected data of 35 patients (42.1 ± 9.1 years, 27 men) who underwent surgery for severe BD-related AR at two tertiary centers. The diagnosis was established based on echocardiographic, surgical, and/or pathological findings in conjunction with the International Study Group criteria for BD. A total of 76 cases of AV surgery in 35 patients were analyzed. Results: A median follow-up duration was 8.0 years (interquartile range, 5.4-14.3 years). PVL developed in 18 patients (51.4{\%}) within 2 years after the first surgery. Six patients who met the diagnostic criteria for BD did not develop PVL, in whom 5 patients took immunosuppressive therapy (IST). However, 4 of 9 patients (44.4{\%}) who did not meet the diagnostic criteria developed PVL, in whom four (44.4{\%}) patients took IST. On multivariable analysis, postoperative IST and concomitant aortic root replacement (ARR) were two independent predictors for less PVL development (HR 0.38, 95{\%} CI 0.17-0.89, p = 0.025 for postoperative IST; HR 0.17, 95{\%} CI 0.08-0.36, p < 0.001 for concomitant ARR). Preoperative IST use did not determine PVL development (p = 0.75). Conclusions: Postoperative, but not preoperative, IST and concomitant ARR were independent predictors of less development of PVL. Special attention is required for early diagnosis BD-related AR, especially in patients not satisfying the current diagnostic criteria.",
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T1 - Predictors of paravalvular aortic regurgitation after surgery for Behcet's disease-related severe aortic regurgitation

AU - Choi, Hong Mi

AU - Kim, Hyung Kwan

AU - Park, Sung Ji

AU - Lee, Hyun Jung

AU - Yoon, Yeonyee E.

AU - Park, Jun Bean

AU - Kim, Yong Jin

AU - Cho, Goo Young

AU - Hwang, In Chang

AU - Sohn, Dae Won

AU - Oh, Jae Kuen

PY - 2019/6/10

Y1 - 2019/6/10

N2 - Background: Behcet's disease (BD)-related aortic regurgitation (AR) is known to be associated with paravalvular leakage (PVL) after successful aortic valve (AV) surgery. This study aimed to determine predictors of PVL after successful AV surgery in BD patients. We retrospectively collected data of 35 patients (42.1 ± 9.1 years, 27 men) who underwent surgery for severe BD-related AR at two tertiary centers. The diagnosis was established based on echocardiographic, surgical, and/or pathological findings in conjunction with the International Study Group criteria for BD. A total of 76 cases of AV surgery in 35 patients were analyzed. Results: A median follow-up duration was 8.0 years (interquartile range, 5.4-14.3 years). PVL developed in 18 patients (51.4%) within 2 years after the first surgery. Six patients who met the diagnostic criteria for BD did not develop PVL, in whom 5 patients took immunosuppressive therapy (IST). However, 4 of 9 patients (44.4%) who did not meet the diagnostic criteria developed PVL, in whom four (44.4%) patients took IST. On multivariable analysis, postoperative IST and concomitant aortic root replacement (ARR) were two independent predictors for less PVL development (HR 0.38, 95% CI 0.17-0.89, p = 0.025 for postoperative IST; HR 0.17, 95% CI 0.08-0.36, p < 0.001 for concomitant ARR). Preoperative IST use did not determine PVL development (p = 0.75). Conclusions: Postoperative, but not preoperative, IST and concomitant ARR were independent predictors of less development of PVL. Special attention is required for early diagnosis BD-related AR, especially in patients not satisfying the current diagnostic criteria.

AB - Background: Behcet's disease (BD)-related aortic regurgitation (AR) is known to be associated with paravalvular leakage (PVL) after successful aortic valve (AV) surgery. This study aimed to determine predictors of PVL after successful AV surgery in BD patients. We retrospectively collected data of 35 patients (42.1 ± 9.1 years, 27 men) who underwent surgery for severe BD-related AR at two tertiary centers. The diagnosis was established based on echocardiographic, surgical, and/or pathological findings in conjunction with the International Study Group criteria for BD. A total of 76 cases of AV surgery in 35 patients were analyzed. Results: A median follow-up duration was 8.0 years (interquartile range, 5.4-14.3 years). PVL developed in 18 patients (51.4%) within 2 years after the first surgery. Six patients who met the diagnostic criteria for BD did not develop PVL, in whom 5 patients took immunosuppressive therapy (IST). However, 4 of 9 patients (44.4%) who did not meet the diagnostic criteria developed PVL, in whom four (44.4%) patients took IST. On multivariable analysis, postoperative IST and concomitant aortic root replacement (ARR) were two independent predictors for less PVL development (HR 0.38, 95% CI 0.17-0.89, p = 0.025 for postoperative IST; HR 0.17, 95% CI 0.08-0.36, p < 0.001 for concomitant ARR). Preoperative IST use did not determine PVL development (p = 0.75). Conclusions: Postoperative, but not preoperative, IST and concomitant ARR were independent predictors of less development of PVL. Special attention is required for early diagnosis BD-related AR, especially in patients not satisfying the current diagnostic criteria.

KW - Aortic regurgitation

KW - Aortic valve surgery

KW - Behcet's disease

KW - Paravalvular leakage

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