Long-Term Outcomes after Aortic Valve and Root Replacement in a Very High-Risk Population

• Published in: Journal of cardiovascular development and disease 2022-06, Vol.9 (6), p.197
• Main Authors: Hlavicka, Jan, Antonov, Kiril, Salem, Razan, Hecker, Florian, Marinos, Spiros, Radwan, Medhat, Emrich, Fabian, Van Linden, Arnaud, Moritz, Anton, Walther, Thomas, Holubec, Tomas
• Format: Article
• Language: English
• Subjects: Aortic dissection; aortic valve and root replacement; Bentall–De Bono operation; Cardiac arrhythmia; Care and treatment; Coronary vessels; Endocarditis; Germany; high-risk population; Medical imaging; Mortality; Patients; Postoperative period; Risk factors; Statistical analysis; Surgery; Sutures; Veins & arteries
• ISSN: 2308-3425; 2308-3425
• DOI: 10.3390/jcdd9060197

: Aortic valve and root replacement (AVRR) is a standardised procedure to treat patients with aortic valve and root disease. In centres with a well-established aortic valve and root repair program (valve repairs and Ross operations), only patients with very complex conditions receive AVRR; this procedure uses a mechanical or biological composite valve graft (modified Bentall-de Bono procedure). The aim of the study was to evaluate the short- and long-term results after AVRR in a high-risk population with complex pathologies. : Between 2005 and 2018, a total of 273 consecutive patients (mean age 64 ± 12.8 years; 23% female) received AVRR. The indication for surgery was an acute type A aortic dissection in 18%, infective endocarditis in 36% and other pathologies in 46% patients; 39% were redo procedures. The median EuroSCORE II was 11.65% (range 1.48-95.63%). Concomitant surgery was required in 157 patients (58%). : The follow-up extended to 5.2 years (range 0.1-15 years) and it was complete in 96% of the patients. The 30-day mortality was 17%. The overall estimated survival at 5 and 10 years was 65% ± 3% and 49% ± 4%, respectively. Univariate and multivariate logistic regression analyses revealed the following risk factors for survival: perioperative neurological dysfunction (OR 5.45), peripheral artery disease (OR 4.4) and re-exploration for bleeding (OR 3.37). : AVRR can be performed with acceptable short- and long-term results in a sick patient population. The Bentall-De Bono procedure may be determined to be suitable for only elderly or high-risk patients. Any other patients should receive an AV repair or the Ross procedure in well-established centres.