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Long-term durability of valve-sparing root replacement in patients with and without connective tissue disease

Read at the 103rd Annual Meeting of The American Association for Thoracic Surgery, Los Angeles, California, May 6-9, 2023.
https://doi.org/10.1016/j.jtcvs.2023.04.033Get rights and content

Abstract

Objective

The goal of this study was to evaluate the long-term outcomes of valve-sparing root replacement in patients with connective tissue disease (CTD) and compare them with patients without CTD who underwent valve-sparing root replacement for root aneurysm.

Methods

Of 487 patients, 380 (78%) did not have CTD and 107 (22%) had CTD; 97 (91%) with Marfan syndrome, 8 (7%) with Loeys-Dietz syndrome, and 2 (2%) with Vascular Ehlers-Danlos syndrome. Operative and long-term outcomes were compared.

Results

The CTD group was younger (36 ± 14 years vs 53 ± 12 years; P < .001), had more women (41% vs 10%; P < .001) and had less hypertension (28% vs 78%; P < .001) and bicuspid aortic valve (8% vs 28%; P < .001). Other baseline characteristics did not differ between the groups. Overall operative mortality was nil (P = 1.000); the incidence of major postoperative complications was 1.2% (0.9% vs 1.3%; P = 1.000) and did not differ between groups. Residual mild aortic insufficiency (AI) was more frequent in the CTD group (9.3% vs 1.3%, P < .001) with no difference in moderate or greater AI. Ten-year survival was 97.3% (97.2% vs 97.4%; log-rank P = .801). Of the 15 patients with residual AI, 1 had none, 11 remained mild, 2 had moderate, and 1 had severe AI on follow-up. Ten-year freedom from moderate/severe AI was 89.6% (hazard ratio, 1.05; 95% CI, 0.8-1.37; P = .750) and 10-year freedom from valve reoperation was 94.9% (hazard ratio, 1.21; 95% CI, 0.43-3.39; P = .717).

Conclusions

The operative outcomes as well as long-term durability of valve-sparing root replacement is excellent in patients with or without CTD. Valve function and durability are not influenced by CTD.

Section snippets

Patient Population and Study Design

From August 2000 to May 2022, 487 consecutive patients in our department with varying degrees of AI underwent VSRR (Figure E1) of whom 107 (22%) had known CTD and 380 (78%) were not diagnosed with any CTD. All baseline characteristics, operative data, and 30-day outcomes were prospectively collected and completed for all patients. All clinical and echocardiographic follow-up information was updated before the analyses for the current study using the hospital electronic medical record. Primary

Clinical Characteristics and Operative Data

Among the CTD group patients, the majority had Marfan syndrome (n = 97 [90.7%]), 8 patients (7.5%) had Loeys-Dietz syndrome, and 2 patients (1.9%) had Vascular Ehler-Danlos syndrome.

Patients with CTD were younger (36 ± 14 years vs 53 ± 11 years; P < .001) (Figure E2 and Table E1), had more women (41% vs 10%; P < .001), had a lower prevalence of hypertension (28% vs 78%; P < .001) or history of smoking (8% vs 20%; P = .008), less bicuspid AV (8% vs 28%; P < .001), were more asymptomatic in New

Discussion

We compared perioperative and long-term outcomes between patients with CTD and patients without CTD who underwent VSRR for dilatation of the aortic root. We have shown that despite higher rates of residual AI, patients with CTD can be effectively treated with VSRR, with excellent long-term durability. The major findings from this study are that both CTD and non-CTD patients appear to provide similar perioperative outcomes, freedom from recurrent AI or reoperation, and late survival.

The

Conclusions

The operative outcomes as well as long-term durability of VSRR are excellent in patients with or without connective tissue disease. Survival, freedom from AI recurrence, and reoperation is similar between the 2 groups, suggesting that valve function and durability are not influenced by connective tissue disease.

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