Preoperative Eccentric Aortic Regurgitation and Outcomes Following Valve-Sparing Root Replacement

• Authors: Dale S Deas, Emory University; Xiaoying Lou, Emory University; Bradley Leshnower, Emory University; Zakaria Almuwaqqat, Emory University; Jose N Binongo, Emory University; LaRonica McPherson, Emory University; Edward Chen, Emory University
• Journal Title: SEMINARS IN THORACIC AND CARDIOVASCULAR SURGERY
• Volume: Volume 33, Number 3
• Publisher: ELSEVIER INC | 2021-01-01, Pages 627-634
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1053/j.semtcvs.2020.12.004
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Public Health
• Keywords: Science & Technology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Cardiovascular System & Cardiology; Valve-sparing root replacement; Aortic valve reimplantation; Eccentric aortic insufficiency; Central aortic insufficiency; David-V valve-sparing root replacement; CUSP REPAIR; REIMPLANTATION; CONDUITS; SEVERITY; IMPACT

Abstract

The David V valve-sparing root replacement (VSRR) is well-established for the treatment of aortic insufficiency (AI) and advanced root aortopathy. The impact of cusp repair in trileaflet aortic valve (TAV) patients, however, with preoperative moderate-severe AI and an eccentric jet is unclear. This study compares outcomes in TAV patients with pre-operative AI >2+ based on jet centricity and cusp repair status. Review of a single institutional database identified 309 consecutive patients undergoing VSRR from 2005 to 2018. Of these, 51 patients had TAV with AI >2+: 25 concentric and 26 eccentric jets. Mean follow-up was 58 (SD = 44) months. Echocardiographic parameters were compared pre- and post-operatively. Kaplan-Meier analysis, longitudinal mixed modeling, and cumulative incidence were used to compare long-term survival, recurrence of AI >1+, and valve specific re-intervention, respectively. The mean age was 48 (SD = 12) years and 84% were male. Differences in preoperative comorbidities and echocardiographic parameters between groups were not statistically significant. Postoperative outcomes were similar in concentric vs. eccentric and cusp vs. no cusp repair. Recurrence of AI>1+ was minimal and unrelated to jet centricity (concentric = 1, eccentric = 3) and cusp repair (no cusp repair = 1, cusp repair = 3) long-term. Aortic valve replacement cumulative incidence was 0% for central and 5% for eccentric at 3-, 5-, and 10-years, respectively. Long-term mortality was similar regardless of jet centricity and cusp repair. In appropriately selected TAV patients with preoperative AI >2+, current results suggest VSRR provides a durable repair regardless of jet centricity or the need for cusp repair based on low rates of reintervention reported.