fate of un-replaced sinuses of valsalva in bicuspid aortic valve disease: follow-up to 17 years chan...
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Fate of Un-replaced Sinuses of Fate of Un-replaced Sinuses of Valsalva in Bicuspid Aortic Valve Valsalva in Bicuspid Aortic Valve
Disease: Follow-up to 17 yearsDisease: Follow-up to 17 years
Chan Park1, Hector Michelena2, Thoralf M. Sundt1
Divisions of Cardiovascular Surgery1 and Cardiovascular Medicine2
Mayo Clinic
Rochester, Minnesota
Patient CharacteristicsPatient Characteristics
Age (yrs)Age (yrs) 62±1362±13
Male (%)Male (%) 75.275.2
F/U period (yrs)F/U period (yrs) 0-17(3.3)0-17(3.3)
Diabetes mellitus (%)Diabetes mellitus (%) 10.110.1
Hypercholesterolemia (%)Hypercholesterolemia (%) 60.660.6
Renal failure (%)Renal failure (%) 2.32.3
NYHA III/IV (%)NYHA III/IV (%) 39.039.0
Coronary artery disease (%)Coronary artery disease (%) 30.730.7
Operative ResultsOperative Results
ACC (min)ACC (min) 68.8±28.968.8±28.9
CPB (min)CPB (min) 96.0±43.796.0±43.7
Circulatory arrest (min)Circulatory arrest (min) 18.5±13.218.5±13.2
Type of Valve (Mech:Bio)Type of Valve (Mech:Bio) 109:109109:109
ProceduresProcedures
NCC procedureNCC procedure 15 (6.9%)15 (6.9%)
Ascending aortoplastyAscending aortoplasty 65 (29.8%)65 (29.8%)
Ascending graftAscending graft 153 (70.2%)153 (70.2%)
Arch surgeryArch surgery 13 (6.0%)13 (6.0%)
Preoperative Echo findingPreoperative Echo finding
DominanceDominance
Stenosis (%)Stenosis (%) 69.669.6
Insufficiency (%)Insufficiency (%) 24.924.9
Mixed (%)Mixed (%) 5.55.5
EF (%)EF (%) 59.5±11.759.5±11.7
Size (mm)Size (mm)
AnnulusAnnulus 25.7±4.625.7±4.6
SinusSinus 40.4±5.740.4±5.7
STJSTJ 34.6±5.334.6±5.3
Ascending aortaAscending aorta 50.6±6.850.6±6.8
OutcomesOutcomes
• Operative mortality: 2.8%• Overall mortality: 28/218 (12.8%)• Cause of death
Cardiac 5/28 (17.9%)
Non-cardiac 11/28 (39.3%)
Unknown 12/28 (42.9%)
Reoperation
• Reoperation: 10/218 (4.6%)
• Indication
Aortic root dilation (1) Ascending aorta dilatation (2)
PVE (3)PVE (3)
PPM (2)PPM (2)
Others (4)Others (4)
Sex
Age
Interval (yrs)
Primary operation
Reason for reoperation Reoperation
M 49 13.2 Aortoplasty PPM AVR+CABG
M 71 0.3 AscAoRp PVE AVR
M 67 9.2Aortoplasty+CABG
Aortic Root and AscAo dilatation
Graft replaceof AoRoot & AscAo
M 65 1.5 Aortoplasty RCA aneurysm CABG
M 40 9.0 Aortoplasty PPM & AscAo dilatation AVR+AscAo replace
M 65 3.8 Aortoplasty PVEHomograft replacement of AoRoot & CABG
M 75 0.9 AscAoRp MediastinitisValveless Homograft AscAo replacement
M 75 0.3 AscAoRp PVEHomograft replacement of AoRoot
M 60 0.1TotalArch+ProxDesc+CABG
Thoracoabdominal aneurysm
Thoracoabdominal aorta replacement
M 63 1.3AscAoRp+PFO closure
Periprosthetic leakageRepair of periprosthetic leakage
Details for ReoperationsDetails for Reoperations
Survival Freedom from ReoperationSurvival Freedom from Reoperation
0
80
100
60
40
20
Pro
bab
ility
(%
)
0 2 4 6 8 10
Follow-up (years)
1 year probability: 97.6%
5 year probabilitiy: 94.9%
10 year probability: 85.5%
Univariate Analysis for Overall SurvivalUnivariate Analysis for Overall Survival
HRHR pp value value
AgeAge 1.081.08 0.0010.001
DMDM 4.994.99 <0.001<0.001
Preop renal failurePreop renal failure 6.866.86 0.0020.002
NYHA (III/IV)NYHA (III/IV) 2.412.41 0.0280.028
CADCAD 3.623.62 <0.001<0.001
Bioprosthetic valveBioprosthetic valve 2.472.47 0.0230.023
Multivariate Analysis for Overall SurvivalMultivariate Analysis for Overall Survival
HRHR pp value value
AgeAge 1.071.07 0.0010.001
DMDM 5.325.32 <0.001<0.001
Preop renal failurePreop renal failure 8.438.43 0.0010.001
NYHA (III/IV)NYHA (III/IV) 2.282.28 0.0440.044
Change of Aortic Size at 5 years Change of Aortic Size at 5 years (n= 28)(n= 28)
0
10
20
30
40
50 Preop Postop
Annulus Sinus STJ AscAo
Size (mm)
*
*†
* p<0.05 preop vs postop, † p<0.001 preop vs postop
Conclusions
• The sinuses of Valsalva rarely dilate The sinuses of Valsalva rarely dilate significantly after AVR and aortic repairsignificantly after AVR and aortic repair
• Separate valve and graft remains a Separate valve and graft remains a reasonable option in the absence of reasonable option in the absence of significant root dilatationsignificant root dilatation
• The ascending aorta remains at risk of late The ascending aorta remains at risk of late dilatation if treated with aortoplastydilatation if treated with aortoplasty