Format

Send to

Choose Destination
J Thorac Cardiovasc Surg. 2014 Jan;147(1):169-77, 178.e1-178.e3. doi: 10.1016/j.jtcvs.2013.09.009. Epub 2013 Oct 29.

Incidence and progression of mild aortic regurgitation after Tirone David reimplantation valve-sparing aortic root replacement.

Author information

1
Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
2
Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, Calif.
3
Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, Stanford, Calif. Electronic address: dcm@stanford.edu.

Abstract

OBJECTIVE:

The study objective was to determine whether recurrent or residual mild aortic regurgitation, which occurs after valve-sparing aortic root replacement, progresses over time.

METHODS:

Between 2003 and 2008, 154 patients underwent Tirone David-V valve-sparing aortic root replacement; 96 patients (62%) had both 1-year (median, 12 ± 4 months) and mid-term (62 ± 22 months) transthoracic echocardiograms available for analysis. Age of patients averaged 38 ± 13 years, 71% were male, 31% had a bicuspid aortic valve, 41% had Marfan syndrome, and 51% underwent aortic valve repair, predominantly cusp free margin shortening.

RESULTS:

Forty-one patients (43%) had mild aortic regurgitation on 1-year echocardiogram. In 85% of patients (n = 35), mild aortic regurgitation remained stable on the most recent echocardiogram (median, 57 ± 20 months); progression to moderate aortic regurgitation occurred in 5 patients (12%) at a median of 28 ± 18 months and remained stable thereafter; severe aortic regurgitation developed in 1 patient, eventually requiring reoperation. Five patients (5%) had moderate aortic regurgitation at 1 year, which did not progress subsequently. Two patients (2%) had more than moderate aortic regurgitation at 1 year, and both ultimately required reoperation.

CONCLUSIONS:

Although mild aortic regurgitation occurs frequently after valve-sparing aortic root replacement, it is unlikely to progress over the next 5 years and should not be interpreted as failure of the valve-preservation concept. Further, we suggest that mild aortic regurgitation should not be considered nonstructural valve dysfunction, as the 2008 valve reporting guidelines would indicate. We need 10- to 15-year follow-up to learn the long-term clinical consequences of mild aortic regurgitation early after valve-sparing aortic root replacement.

KEYWORDS:

26.1; 35.1; AI; AR; BAV; CTD; CVG; IQR; MFS; Marfan syndrome; TAV; TTE; V-SARR; aortic insufficiency; aortic regurgitation; bicuspid aortic valve; composite valve graft; connective tissue disorder; interquartile range; transthoracic echocardiogram; trileaflet aortic valve; valve-sparing aortic root replacement

Comment in

PMID:
24176278
DOI:
10.1016/j.jtcvs.2013.09.009
[Indexed for MEDLINE]
Free full text

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center