Contemporary Valvular Mechanisms of Aortic Regurgitation in Tricuspid Aortic Valves: Importance in Repair Versus Replacement Strategy

This study was performed to determine cusp causes of aortic regurgitation in patients with tricuspid aortic valves without significant aortic dilatation and define cusp pathologies amenable to surgical repair (aortic valve repair [AVr]) versus aortic valve replacement. We retrospectively reviewed su...

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Bibliographic Details
Published in:Journal of the American Heart Association 2024-05, Vol.13 (9), p.e032532-e032532
Main Authors: Almaghrabi, Saifalislam, Michelena, Hector, Jelenc, Matija, Abeln, Karen B, Ehrlich, Tristan, Schäfers, Hans-Joachim
Format: Article
Language:English
Subjects:
Aged
aortic regurgitation
Aortic Valve - diagnostic imaging
Aortic Valve - physiopathology
Aortic Valve - surgery
Aortic Valve Insufficiency - diagnostic imaging
Aortic Valve Insufficiency - physiopathology
Aortic Valve Insufficiency - surgery
Cardiac Valve Annuloplasty - methods
Echocardiography, Transesophageal
Female
Heart Valve Prosthesis Implantation - adverse effects
Humans
Male
Middle Aged
Original Research
Registries
Retrospective Studies
Treatment Outcome
tricuspid aortic valve
Tricuspid Valve - diagnostic imaging
Tricuspid Valve - physiopathology
Tricuspid Valve - surgery
valvular pathology
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Summary:This study was performed to determine cusp causes of aortic regurgitation in patients with tricuspid aortic valves without significant aortic dilatation and define cusp pathologies amenable to surgical repair (aortic valve repair [AVr]) versus aortic valve replacement. We retrospectively reviewed surgical reports of consecutive adults with tricuspid aortic valves undergoing surgery for clinically significant aortic regurgitation within a prospective registry from January 2005 to September 2019. Valvular mechanisms were determined by systematic in vivo intraoperative quantification methods. Of 516 patients, 287 (56%) underwent repair (AVr; mean±SD age, 59.9±12.4 years; 81% men) and 229 (44%) underwent replacement (aortic valve replacement; mean±SD age, 62.8±13.8 years [ =0.01 compared to AVr]; 67% men). A single valvular mechanism was present in 454 patients (88%), with cusp prolapse (46%), retraction (24%), and perforation (18%) being the most common. Prolapse involved the right cusp in 86% of cases and was more frequent in men (
ISSN:2047-9980
2047-9980
DOI:10.1161/JAHA.123.032532