Results of aortic valve repair according
to valve morphology and surgical
techniques.
Khalil Fattouch, 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:
1.
Valve
morphology
(tricuspid
or
bicuspid)
Surgical techniques: plication, free
edge reinforcement with Gore-Tex,
“chordae technique” (described by us)
2.
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, tromboembolism.
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
Patients Baseline Characteristics
Variables
N° of patients (%)
Age (years)
Male gender
Diabetes
COPD
Hypertension
Creatinine > 1.5
Angina
Atrial fibrillation
5812
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
Aneurysm
Marfan
55 (25.4%)
111 (51.3%)
36(16.6%)
Type of Aortic regurgitation:
Type I
Type II
Type III
55 (25.5%)
126 (58.3%)
35 (16.2%)
Grade of AR:
II
III
IV
28(13%)
30 (13.8%)
158 (73%)
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
Bypass time (min)
Cross-clamp time (min)
Logistic EuroSCORE
22 (10%)
78 (36%)
69 (32%)
12 (5.5%)
12146
8732
5.23.1
Early Mortality
6 (2.7%)
Percentage of Survival (%)
Overall survival rate
Overall survival rate was 91.5%
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
Freedom from valve related events (%)
Freedom from valve-related events for
bicuspid vs tricuspid
years
Freedom from valve related events (%)
Freedom from valve-related events for
bicuspid vs tricuspid
(p<0.01)
years
Percentage of Survival (%)
Freedom from valve-related events according
to functional classification of AR
Type I
Type II
Type III (p<0.001)
years
Percentage of Survival (%)
Freedom from valve-related events according
to surgical techniques
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