Khalil Fattouch, Roberta Sampognaro, Giuseppe Speziale, Khalil Fattouch, Roberta Sampognaro, Giuseppe Speziale, Marco Caruso, Pietro Dioguardi, Salvatore Novo, Giovanni Marco Caruso, Pietro Dioguardi, Salvatore Novo, Giovanni

Ruvolo. Ruvolo.

Disclosures: NoneDisclosures: None

Aortic Symposium 2010 Sheraton Hotel and Towers, New York, USA.

Results of aortic valve repair according to valve morphology and surgical

techniques.

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:

1.Valve morphology (tricuspid or bicuspid)

2.Surgical techniques: plication, free edge reinforcement with Gore-Tex, “chordae technique” (described by us)

Study EndpointsStudy 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 Patients and MethodsMethods

• 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

Variables N° of patients (%)

Age (years)Male gender DiabetesCOPDHypertensionCreatinine > 1.5AnginaAtrial fibrillation

5812 166 (76.8%)22 (10%)21 (9.7%) 101 (46.7%)11 (5%)6 (2.7%)12(5.5%)

Bicuspid 66 (27.7%)

NYHA class II III IV

125(57.8%)36 (16.5%)24(11%)

Patients Baseline Characteristics

Variables

N° of patients (%)

Ascending Aortic Pathology:Anulo-aortic ectasia AneurysmMarfan

55 (25.4%)111 (51.3%)36(16.6%)

Type of Aortic regurgitation:Type IType IIType III

55 (25.5%)126 (58.3%)35 (16.2%)

Grade of AR:IIIIIIV

28(13%)30 (13.8%)158 (73%)

Patients Baseline Characteristics

Intraoperative Characteristics

Variables N° of Patients

Valve repair methods: Sub-commissural plasty Plication Free edge reinforcement with Gore-Tex Chordae technique

138 (63.8%) 84 (38.8%) 80 (37%)52(37.5%)

Associated surgical procedures: CABG Aortic valve-sparing root replacement Ascending aortic resection Mitral valve repair

22 (10%)78 (36%)69 (32%)12 (5.5%)

Bypass time (min)Cross-clamp time (min)Logistic EuroSCORE

Early Mortality

12146 8732 5.23.1

6 (2.7%)

Overall survival rate P

erce

ntag

e of

Sur

viva

l (%

)

years

Overall survival rate was 91.5%

Freedom from reoperation and from recurrence of AR ≥ grade II

years

Freedom from reoperation was 94.8%

Freedom from AR grade ≥ II was 85.5%

Freedom from valve-related events for Freedom from valve-related events for bicuspid vs tricuspidbicuspid vs tricuspid

years

Fre

edom

from

val

ve r

elat

ed e

vent

s (%

)

Freedom from valve-related events for Freedom from valve-related events for bicuspid vs tricuspidbicuspid vs tricuspid

years

Fre

edom

from

val

ve r

elat

ed e

vent

s (%

)

(p<0.01)

Type I

Type II

Type III (p<0.001)Per

cent

age

of S

urvi

val (

%)

years

Freedom from valve-related events accordingFreedom from valve-related events according to functional classification of AR to functional classification of AR

Plication

Free edge reinforcement with GoreTex (p<0.01)

The chordae technique

Per

cent

age

of S

urvi

val (

%)

years

Freedom from valve-related events accordingFreedom from valve-related events according to surgical techniques to surgical techniques

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