Repeat aortic valve replacement for failing aortic root homograft

Ahmed F. Sedeek, Kevin L. Greason, Vuyisile T Nkomo, Mackram Eleid, Simon Maltais, Eric E. Williamson, Juan A. Crestanello, David Holmes, Gurpreet S Sandhu, Hartzell V Schaff

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective: Published data are limited in comparison of transcatheter aortic valve replacement with surgical aortic valve replacement for the failing aortic root homograft. We reviewed our experience with repeat aortic valve replacement in failing aortic root homografts to compare outcomes of transcatheter aortic valve replacement and surgical aortic valve replacement. Methods: We retrospectively reviewed the records of 51 patients with failing aortic root homografts who received repeat aortic valve replacement between October 2000 and May 2018. Operation included transcatheter aortic valve replacement in 11 patients between June 2014 and May 2018. Surgical aortic valve replacement was performed in 40 patients between October 2000 and January 2018, and operation included repeat composite aortic valve/root replacement in 30 patients (75%). Results: Patient age was 59 years (interquartile range, 50-72 years), sex was female in 9 patients (18%), and time to repeat aortic valve replacement was 12 years (interquartile range, 8-13). Procedure-related complications occurred in 37 patients (73%): vascular injury (any) more commonly in the transcatheter aortic valve replacement group (36% vs 5%; P =.015), bleeding (major or life-threatening) more commonly in the surgical aortic valve replacement group (58% vs 0%; P <.001), and sternal reentry injury only in the surgical aortic valve replacement group (n = 6, 15%). There were 3 procedure-related deaths in the surgical aortic valve replacement group (8%) and 1 (9%) in the transcatheter aortic valve replacement group (P = 1.000). Subsequent cardiac operation occurred in no patients in the transcatheter aortic valve replacement group and in 5 patients in the surgical aortic valve replacement group. Conclusions: Repeat aortic valve replacement for failing aortic root homograft is associated with notable risk of morbidity and mortality regardless of replacement technique. Avoidance of vascular injury could lead to improved outcomes in the transcatheter aortic valve replacement group.

Original languageEnglish (US)
JournalJournal of Thoracic and Cardiovascular Surgery
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Aortic Valve
Allografts
Surgical Instruments
Vascular System Injuries
Transcatheter Aortic Valve Replacement
Hemorrhage
Morbidity

Keywords

  • homograft failure
  • homograft senescence
  • surgical aortic valve replacement
  • transcatheter valve insertion
  • transcatheter valve replacement
  • valve in valve

ASJC Scopus subject areas

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

Cite this

Repeat aortic valve replacement for failing aortic root homograft. / Sedeek, Ahmed F.; Greason, Kevin L.; Nkomo, Vuyisile T; Eleid, Mackram; Maltais, Simon; Williamson, Eric E.; Crestanello, Juan A.; Holmes, David; Sandhu, Gurpreet S; Schaff, Hartzell V.

In: Journal of Thoracic and Cardiovascular Surgery, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "Objective: Published data are limited in comparison of transcatheter aortic valve replacement with surgical aortic valve replacement for the failing aortic root homograft. We reviewed our experience with repeat aortic valve replacement in failing aortic root homografts to compare outcomes of transcatheter aortic valve replacement and surgical aortic valve replacement. Methods: We retrospectively reviewed the records of 51 patients with failing aortic root homografts who received repeat aortic valve replacement between October 2000 and May 2018. Operation included transcatheter aortic valve replacement in 11 patients between June 2014 and May 2018. Surgical aortic valve replacement was performed in 40 patients between October 2000 and January 2018, and operation included repeat composite aortic valve/root replacement in 30 patients (75{\%}). Results: Patient age was 59 years (interquartile range, 50-72 years), sex was female in 9 patients (18{\%}), and time to repeat aortic valve replacement was 12 years (interquartile range, 8-13). Procedure-related complications occurred in 37 patients (73{\%}): vascular injury (any) more commonly in the transcatheter aortic valve replacement group (36{\%} vs 5{\%}; P =.015), bleeding (major or life-threatening) more commonly in the surgical aortic valve replacement group (58{\%} vs 0{\%}; P <.001), and sternal reentry injury only in the surgical aortic valve replacement group (n = 6, 15{\%}). There were 3 procedure-related deaths in the surgical aortic valve replacement group (8{\%}) and 1 (9{\%}) in the transcatheter aortic valve replacement group (P = 1.000). Subsequent cardiac operation occurred in no patients in the transcatheter aortic valve replacement group and in 5 patients in the surgical aortic valve replacement group. Conclusions: Repeat aortic valve replacement for failing aortic root homograft is associated with notable risk of morbidity and mortality regardless of replacement technique. Avoidance of vascular injury could lead to improved outcomes in the transcatheter aortic valve replacement group.",
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AU - Sedeek, Ahmed F.

AU - Greason, Kevin L.

AU - Nkomo, Vuyisile T

AU - Eleid, Mackram

AU - Maltais, Simon

AU - Williamson, Eric E.

AU - Crestanello, Juan A.

AU - Holmes, David

AU - Sandhu, Gurpreet S

AU - Schaff, Hartzell V

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N2 - Objective: Published data are limited in comparison of transcatheter aortic valve replacement with surgical aortic valve replacement for the failing aortic root homograft. We reviewed our experience with repeat aortic valve replacement in failing aortic root homografts to compare outcomes of transcatheter aortic valve replacement and surgical aortic valve replacement. Methods: We retrospectively reviewed the records of 51 patients with failing aortic root homografts who received repeat aortic valve replacement between October 2000 and May 2018. Operation included transcatheter aortic valve replacement in 11 patients between June 2014 and May 2018. Surgical aortic valve replacement was performed in 40 patients between October 2000 and January 2018, and operation included repeat composite aortic valve/root replacement in 30 patients (75%). Results: Patient age was 59 years (interquartile range, 50-72 years), sex was female in 9 patients (18%), and time to repeat aortic valve replacement was 12 years (interquartile range, 8-13). Procedure-related complications occurred in 37 patients (73%): vascular injury (any) more commonly in the transcatheter aortic valve replacement group (36% vs 5%; P =.015), bleeding (major or life-threatening) more commonly in the surgical aortic valve replacement group (58% vs 0%; P <.001), and sternal reentry injury only in the surgical aortic valve replacement group (n = 6, 15%). There were 3 procedure-related deaths in the surgical aortic valve replacement group (8%) and 1 (9%) in the transcatheter aortic valve replacement group (P = 1.000). Subsequent cardiac operation occurred in no patients in the transcatheter aortic valve replacement group and in 5 patients in the surgical aortic valve replacement group. Conclusions: Repeat aortic valve replacement for failing aortic root homograft is associated with notable risk of morbidity and mortality regardless of replacement technique. Avoidance of vascular injury could lead to improved outcomes in the transcatheter aortic valve replacement group.

AB - Objective: Published data are limited in comparison of transcatheter aortic valve replacement with surgical aortic valve replacement for the failing aortic root homograft. We reviewed our experience with repeat aortic valve replacement in failing aortic root homografts to compare outcomes of transcatheter aortic valve replacement and surgical aortic valve replacement. Methods: We retrospectively reviewed the records of 51 patients with failing aortic root homografts who received repeat aortic valve replacement between October 2000 and May 2018. Operation included transcatheter aortic valve replacement in 11 patients between June 2014 and May 2018. Surgical aortic valve replacement was performed in 40 patients between October 2000 and January 2018, and operation included repeat composite aortic valve/root replacement in 30 patients (75%). Results: Patient age was 59 years (interquartile range, 50-72 years), sex was female in 9 patients (18%), and time to repeat aortic valve replacement was 12 years (interquartile range, 8-13). Procedure-related complications occurred in 37 patients (73%): vascular injury (any) more commonly in the transcatheter aortic valve replacement group (36% vs 5%; P =.015), bleeding (major or life-threatening) more commonly in the surgical aortic valve replacement group (58% vs 0%; P <.001), and sternal reentry injury only in the surgical aortic valve replacement group (n = 6, 15%). There were 3 procedure-related deaths in the surgical aortic valve replacement group (8%) and 1 (9%) in the transcatheter aortic valve replacement group (P = 1.000). Subsequent cardiac operation occurred in no patients in the transcatheter aortic valve replacement group and in 5 patients in the surgical aortic valve replacement group. Conclusions: Repeat aortic valve replacement for failing aortic root homograft is associated with notable risk of morbidity and mortality regardless of replacement technique. Avoidance of vascular injury could lead to improved outcomes in the transcatheter aortic valve replacement group.

KW - homograft failure

KW - homograft senescence

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KW - transcatheter valve insertion

KW - transcatheter valve replacement

KW - valve in valve

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