University of Palermo Cardiac Surgery Unit Results of aortic valve repair according to valve morphology and surgical techniques. KhalilFattouch, Roberta Sampognaro, Giuseppe Speziale, Marco Caruso, Pietro Dioguardi, Salvatore Novo, Giovanni Ruvolo. Disclosures: None Aortic Symposium 2010 Sheraton Hotel and Towers, New York, USA.
Background • In the last decade, results of aortic valve repair were dramaticaly improved in term of mortality and freedom from aortic valve regurgitation and reoperation • Several techniques were used for aortic valve repair in bicuspid and tricuspid aortic valve.
Study endpoints • To assess postoperative outcome of aortic valve repair according to: • Valve morphology (tricuspid or bicuspid) • Surgical techniques: plication, free edge reinforcement with Gore-Tex, “chordae technique” (described by us)
Study Endpoints Evaluate the impact of AV repair on 6-year freedom: • from overall and cardiac-related death • from reoperation on aortic valve • from reccurrent aortic valve regurgitation grade ≥ II Valve-related events were as follows: reccurent AR, reoperation, endocarditis, stenosis, trombo-embolism.
Patients and Methods • Since February 2003, 216 patients with aortic regurgitation underwent valve repair in our institution. • Patients were classified preoperatively according to functional classification: Type I in 55 pts (25.5%), Type II in 126 (58.3%) and Type III in 35 (16.2%). • 66 pts (27.7%) had bicuspid valve
Overall survival rate Overall survival rate was 91.5% Percentage of Survival (%) years
Freedom from reoperation and from recurrence of AR ≥ grade II Freedom from reoperation was 94.8% Freedom from AR grade ≥ II was 85.5% years
Freedomfromvalve-relatedeventsforbicuspid vs tricuspid Freedom from valve related events (%) years
Freedomfromvalve-relatedeventsforbicuspid vs tricuspid Freedom from valve related events (%) (p<0.01) years
Freedomfromvalve-relatedeventsaccording tofunctionalclassificationof AR Percentage of Survival (%) Type I Type II Type III (p<0.001) years
Freedomfromvalve-relatedeventsaccording tosurgicaltechniques Percentage of Survival (%) Plication Free edge reinforcement with GoreTex (p<0.01) The chordae technique years
Conclusions • Aortic valve repair can be performed • with low early (2.7%) and late mortality. • Late survival rate was 91.5% and late cardiac related death • was 6%. • Overall 6-year aortic regurgitation recurrence (grade≥2) • was 14.5% • Overall incidence of aortic valve reoperation after valve • repair was 5.2%.
Conclusions • Optimal results was observed for tricuspid and pliable bicuspid valve • Optimal results was observed for Type I and II. • Better results for plicatio and The chordae technique respect to only free edge reinforcement