Post on 24-Feb-2021
transcript
Why and when to repair the aortic valve?
Jan Vojacek, M.D., Ph.D.Professor of Cardiac Surgery
Department of Cardiac Surgery, Charles UniversityUniversity Hospital Hradec Kralove
Czech Republic
Reconstruction of the Aortic Valve and Root: A practical approach
Homburg, September 18 – 20, 2019
Alternatives to aortic valve repair in young adults
VALVE RELATED COMPLICATIONS
The long-term results of mechanical and bioprosthetic AVR
Oxenham H et al. Twenty year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses. Heart, 2003.
Major events:
- reoperation
- TE complications
- Bleeding complications
- PVE
The long-term results of mechanical and bioprosthetic AVRA
LL
VA
LV
E-R
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AT
ED
CO
MP
LIC
AT
ION
S (
%)
Hammermeister et al. Outcomes 15 years after valve replacement with a mechanical versus a bioprosthetic valve: final report of the
Veterans Affairs randomized trial. J Am Coll Cardiol. 2000 Oct;36(4):1152-8.
The long-term results of mechanical and bioprosthetic AVR
Stassano P et al. Aortic valve replacement: a prospective randomized evaluation of mechanical versus biological valves in patients
ages 55 to 70 years. J Am Coll Cardiol. 2009 Nov 10;54(20):1862-8.
Mech: 70%
Bio : 40%
EJCTS 2006
EJCTS 2006
EJCTS 2006
EJCTS 2006
EJCTS 2006
Life expectancy after mechanical AVR??
Life expectancy after mechanical AVR??
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25 35 45 55Mea
n li
fe e
xpec
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year
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Age at surgery (years)
General Population- Life expectancy
Mechanical AVR -Life expectancy
Korteland NM et al. Mechanical aortic valve replacement in non-elderly adults:
meta-analysis and microsimulation. Eur Heart J. 2017 Dec 1;38(45):3370-3377
2014
450 patientsage< 65 years
Life expectancy after biological AVR
Microsimulation-based age-specific mean life expectancy after bioAVRcompared with the age- and sex-matched general population
20 years
The long-term results of VSARR
David TE et al. A quarter of a century of experience with aortic valve-sparing operations. J Thorac Cardiovasc Surg 2014;148:872-80
Freedom from ReDo at
18 years: 94.8%
In Hospital mortality: 1%
371 patients
The long-term results of VSARR
Schäfers et al. Reexamining remodeling. J Thorac CardiovascSurg 2015;149:S30-6
747 patientsIn-Hospital mortality: 2%
Freedom from ReDo in tricuspid aortic valve at 15 years: 95%
The long-term results of VSARR
Arabkhani et al. Reported Outcome After Valve-Sparing Aortic Root Replacement for Aortic Root Aneurysm: A Systematic Review and Meta-Analysis. Ann Thorac Surg 2015Sep;100(3):1126-31.
Cumulative risk of hemorrhage, TE = 0,64 (6% at 10 years)
The long-term results of VSARR
Arabkhani et al. Reported Outcome After Valve-Sparing Aortic Root Replacement for Aortic Root Aneurysm: A Systematic Review and Meta-Analysis. Ann Thorac Surg 2015Sep;100(3):1126-31.
Risk of ReDo: 13% at 10 years
Aicher D et al. Aortic valve repair leads to a low incidence of valve-related complications. Eur J Cardiothorac
Surg. 2010 Jan;37(1):127-32.
Freedom from all valve-related complications
(88%)
The long-term results of aortic valve repair
Aicher D et al. Aortic valve repair leads to a low incidence of valve-related complications. Eur J Cardiothorac Surg.
2010 Jan;37(1):127-32.
Freedom from all valve-related complications
(88%)
Freedom from TEC: 97%
Freedom from IE: 95%
The long-term results of aortic valve repair
Price J, De Kerchove L, Glineur D, Vanoverschelde JL, Noirhomme P, El Khoury G.Risk of valve-related
events after aortic valve repair. Ann Thorac Surg. 2013 Feb;95(2):606-13.
Freedom from aortic valve reoperation
Results of bicuspid aortic valve repair
Holubec T, Zacek P, Jamaliramin M, Tuna M, Nedbal P, Dominik J, Harrer J, Falk V, Vojacek J. Valvecuspidity: a risk factor for aortic valve repair? J Card Surg. 2014 Sep;29(5):585-92.
Results of bicuspid aortic valve repairFr
ee
do
m f
rom
re
op
era
tio
n
Follow up (months)
295 patients181 with BAV
Non significant
When??? – patient selection
AR – pure/not mixed lesions
TAV/BAV w/wo aortic dilatation
Only moderate degenerative changes- limited calcification
Not restricted leaflets (gH)
Unicuspid aortic valve
Thank you for your attention
The long-term results of VSARR and the Bentall procedure
Mookhoek A et al. Bentall Procedure: A Systematic Review and Meta-Analysis. Ann ThoracSurg. 2016 Feb 5. pii: S0003-4975(15)01762-2.
Bentall VSARR
Reoperation 0,7%yr 1,32%yr
TE 1,1%yr 0,4%yr
Bleeding 1,0%yr 0,2%yr
Linearized risk of late outcome events
Arabkhani et al. Reported Outcome After Valve-Sparing Aortic Root Replacement for Aortic Root Aneurysm: A Systematic Review and Meta-Analysis. Ann Thorac Surg 2015Sep;100(3):1126-31.
The long-term results of VSARR and the Bentall procedure
Mookhoek A et al. Bentall Procedure: A Systematic Review and Meta-Analysis. Ann ThoracSurg. 2016 Feb 5. pii: S0003-4975(15)01762-2.
Bentall VSARR
Reoperation 0,7%yr 1,32%yr
TE 1,1%yr 0,4%yr
Bleeding 1,0%yr 0,2%yr
Linearized risk of late outcome events
Arabkhani et al. Reported Outcome After Valve-Sparing Aortic Root Replacement for Aortic Root Aneurysm: A Systematic Review and Meta-Analysis. Ann Thorac Surg 2015Sep;100(3):1126-31.
The long-term results of VSARR and the Bentall procedure
Mookhoek A et al. Bentall Procedure: A Systematic Review and Meta-Analysis. Ann ThoracSurg. 2016 Feb 5. pii: S0003-4975(15)01762-2.
Bentall VSARR
Reoperation 0,7%yr 1,32%yr
TE 1,1%yr 0,4%yr
Bleeding 1,0%yr 0,2%yr
Linearized risk of late outcome events
Arabkhani et al. Reported Outcome After Valve-Sparing Aortic Root Replacement for Aortic Root Aneurysm: A Systematic Review and Meta-Analysis. Ann Thorac Surg 2015Sep;100(3):1126-31.
The long term results of mechanical and bioprosthetic AVR
Oxenham H et al. Twenty year comparison of a Bjork-Shiley mechanical heart valve with porcine bioprostheses. Heart, 2003.
Major events:
- reoperation
- TE complications
- Bleeding complications
- PVE
2014
450 patientsage< 65 years