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Aortic insufficiency following balloon aortic valvuloplasty does not impact long-term autograft durability after the Ross procedure.
- Source :
-
The Journal of thoracic and cardiovascular surgery [J Thorac Cardiovasc Surg] 2024 Nov; Vol. 168 (5), pp. 1301-1309.e2. Date of Electronic Publication: 2024 Jan 22. - Publication Year :
- 2024
-
Abstract
- Objective: Preoperative aortic insufficiency (AI) is associated with inferior autograft durability after the Ross procedure. However, many patients with aortic stenosis (AS) undergo balloon aortic valvuloplasty (BAV) early and present with longstanding AI before Ross. We studied how BAV and subsequent valvular pathology impacts autograft durability.<br />Methods: Patients undergoing the Ross operation from 1993 to 2020 were identified. Those who underwent BAV before Ross were compared with patients who did not undergo BAV and underwent Ross for predominant AI (AI group) or AS (AS group). Those who underwent previous open surgical aortic valve intervention were excluded. Primary outcome of interest was autograft failure, defined as a composite of autograft reintervention or severe insufficiency.<br />Results: A total of 198 patients were included. Seventy-nine (39.9%) underwent BAV and subsequently underwent the Ross for predominant AI (45.6%) or AS (54.4%). Of patients who did not undergo BAV, 66 (33.3%) presented with predominant AI and 53 (26.8%) with AS. Freedom from autograft failure at 15 years was 90%, 92%, and 62% in BAV, AS, and AI groups, respectively. The AI group was at significantly increased risk of long-term autograft failure (hazard ratio, 5.6; P = .01), whereas the AS and BAV groups had similar, low risk (hazard ratio, 1.1; P = .91). Autograft durability was similar among patients who received BAV and presented with AS or AI before the Ross (P = .84).<br />Conclusions: BAV before the Ross procedure is common in patients with AS. These patients have excellent long-term autograft durability regardless of preoperative valvular pathology and should strongly be considered for the Ross operation.<br />Competing Interests: Conflict of Interest Statement Dr Takayama reported speaker with Terumo, consultant with Artivion and Edwards, and research grant from the Rudin Foundation. All other authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.<br /> (Copyright © 2024 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Humans
Male
Female
Retrospective Studies
Adult
Time Factors
Treatment Outcome
Heart Valve Prosthesis Implantation adverse effects
Heart Valve Prosthesis Implantation methods
Risk Factors
Middle Aged
Risk Assessment
Aortic Valve Insufficiency surgery
Aortic Valve Insufficiency etiology
Balloon Valvuloplasty adverse effects
Aortic Valve Stenosis surgery
Autografts
Aortic Valve surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1097-685X
- Volume :
- 168
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- The Journal of thoracic and cardiovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 38266983
- Full Text :
- https://doi.org/10.1016/j.jtcvs.2024.01.024