The Journal of Thoracic and Cardiovascular Surgery
AdultLong-term durability of valve-sparing root replacement in patients with and without connective tissue disease
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.
References (35)
- et al.
Elective aortic root replacement in North America: analysis of STS Adult Cardiac Surgery database
Ann Thorac Surg
(2019) - et al.
Contemporary results for proximal aortic replacement in North America
J Am Coll Cardiol
(2012) - et al.
Long-term results of aortic valve-sparing operations for aortic root aneurysm
J Thorac Cardiovasc Surg
(2006) - et al.
Long-term results of aortic root repair using the reimplantation technique
J Thorac Cardiovasc Surg
(2013) - et al.
Valve-sparing aortic root replacement in bicuspid aortic valves: a reasonable option?
J Thorac Cardiovasc Surg
(2004) - et al.
Valve sparing-root replacement with the reimplantation technique to increase the durability of bicuspid aortic valve repair
J Thorac Cardiovasc Surg
(2011) - et al.
Root remodeling and aortic valve repair for unicuspid aortic valve
Ann Thorac Surg
(2014) - et al.
Valve-sparing root replacement in patients with bicuspid aortopathy: an analysis of cusp repair strategy and valve durability
J Thorac Cardiovasc Surg
(2021) - et al.
Midterm outcomes of aortic root surgery in patients with Marfan syndrome: a prospective, multicenter, comparative study
J Thorac Cardiovasc Surg
(2023) - et al.
Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Magnetic Resonance
J Am Soc Echocardiogr
(2017)
Outcomes of aortic valve-sparing operations in Marfan syndrome
J Am Coll Cardiol
Mechanical and histological study of aortic valve tissue from a patient with Marfan's disease
Atherosclerosis
Pathogenesis of aortic wall complications in Marfan syndrome
Cardiovasc Pathol
Transcatheter valve-in-valve vs surgical replacement of failing Stented aortic biological valves
Ann Thorac Surg
Valve-sparing root replacement compared with composite valve graft procedures in patients with aortic root dilation
J Am Coll Cardiol
Effects of institutional volumes on operative outcomes for aortic root replacement in North America
J Thorac Cardiovasc Surg
A new approach to the assessment of aortic cusp geometry
J Thorac Cardiovasc Surg
Cited by (2)
Commentary: Cooking up a durable valve-sparing root replacement: Great ingredients make great outcomes
2024, Journal of Thoracic and Cardiovascular Surgery