Durability of Aortic Valve Cusp Repair With and Without Annular Support

Ahmad Zeeshan; Jay J. Idrees; Douglas R. Johnston; Jeevanantham Rajeswaran; Eric E. Roselli; Edward G. Soltesz; A. Marc Gillinov; Brian Griffin; Richard Grimm; Donald F. Hammer; Gösta B. Pettersson; Eugene H. Blackstone; Joseph F. Sabik; Lars G. Svensson

doi:10.1016/j.athoracsur.2017.09.019

Durability of Aortic Valve Cusp Repair With and Without Annular Support

Ahmad Zeeshan, Jay J. Idrees, Douglas R. Johnston, Jeevanantham Rajeswaran, Eric E. Roselli, Edward G. Soltesz, A. Marc Gillinov, Brian Griffin, Richard Grimm, Donald F. Hammer, Gösta B. Pettersson, Eugene H. Blackstone, Joseph F. Sabik, Lars G. Svensson^*

^*Corresponding author for this work

Surgery, Cardiac Surgery Division

Research output: Contribution to journal › Article › peer-review

51 Scopus citations

Abstract

Background: To determine the value of aortic valve repair rather than replacement for valve dysfunction, we assessed late outcomes of various repair techniques in the contemporary era. Methods: From January 2001 to January 2011, aortic valve repair was planned in 1,124 patients. Techniques involved commissural figure-of-8 suspension sutures (n = 63 [6.2%]), cusp repair with commissuroplasty (n = 481 [48%]), debridement (n = 174 [17%]), free-margin plication (n = 271 [27%]) or resection (n = 75) or both, or annulus repair with resuspension (n = 230 [23%]), root reimplantation (n = 252 [25%]), or remodeling (n = 35 [3.5%]). Results: Planned repair was aborted for replacement in 115 patients (10%); risk factors included greater severity of aortic regurgitation (AR; p = 0.0002) and valve calcification (p < 0.0001). In-hospital outcomes for the remaining 1,009 patients included death (12 [1.2%]), stroke (13 [1.3%]), and reoperation for valve dysfunction (14 [1.4%]). Freedom from aortic valve reoperation at 1, 5, and 10 years was 97%, 93%, and 90%, respectively. Figure-of-8 suspension sutures, valve resuspension, and root repair and replacement were least likely to require reoperation; cusp repair with commissural sutures, plication, and commissuroplasty was most likely (p < 0.05). Survival at 1, 5, and 10 years was 96%, 92%, and 83%. Immediate postoperative AR grade was none-mild (94%), moderate (5%), and severe (1%). At 10 years after repair, AR grade was none (20%), mild (33%), moderate (26%), and severe (21%). Patients undergoing root procedures were less likely to have higher-grade postoperative AR (p < 0.0001). Conclusions: Valve repair is effective and durable for treating aortic valve dysfunction. Greater severity of AR preoperatively is associated with higher likelihood of repair failure. Commissural figure-of-8 suspension sutures and repair with annular support have the best long-term durability.

Original language	English (US)
Pages (from-to)	739-748
Number of pages	10
Journal	Annals of Thoracic Surgery
Volume	105
Issue number	3
DOIs	https://doi.org/10.1016/j.athoracsur.2017.09.019
State	Published - Mar 2018

Funding

This study was partly funded by the Gus P. Karos Registry Fund, the Reiman Foundation, the David Whitmire Hearst, Jr. Foundation, the Anderson Family Foundation, the Judith Dion Pyle Endowed Chair in Heart Valve Research, the John and Rosemary Brown Endowed Chair in Cardiovascular Medicine, the Peter and Elizabeth C. Tower and Family Endowed Chair in Cardiothoracic Research, and the Drs Sidney and Becca Fleischer Heart and Vascular Education Chair. Dr Svensson is an unpaid member of the executive committee for PARTNER trials I and II, chairman of the PARTNER Publication Committee, and an unpaid member of the executive committee of the COMMENCE (ProspeCtive, nOn-randoMized, MulticENter Clinical Evaluation of Edwards Pericardial Bioprostheses With a New Tissue Treatment Platform) trial, sponsored by Edwards Lifesciences.

ASJC Scopus subject areas

Surgery
Pulmonary and Respiratory Medicine
Cardiology and Cardiovascular Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.athoracsur.2017.09.019

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Zeeshan, A., Idrees, J. J., Johnston, D. R., Rajeswaran, J., Roselli, E. E., Soltesz, E. G., Gillinov, A. M., Griffin, B., Grimm, R., Hammer, D. F., Pettersson, G. B., Blackstone, E. H., Sabik, J. F., & Svensson, L. G. (2018). Durability of Aortic Valve Cusp Repair With and Without Annular Support. Annals of Thoracic Surgery, 105(3), 739-748. https://doi.org/10.1016/j.athoracsur.2017.09.019

@article{aaa83eb38db84aca9b85f227880a71da,

title = "Durability of Aortic Valve Cusp Repair With and Without Annular Support",

abstract = "Background: To determine the value of aortic valve repair rather than replacement for valve dysfunction, we assessed late outcomes of various repair techniques in the contemporary era. Methods: From January 2001 to January 2011, aortic valve repair was planned in 1,124 patients. Techniques involved commissural figure-of-8 suspension sutures (n = 63 [6.2%]), cusp repair with commissuroplasty (n = 481 [48%]), debridement (n = 174 [17%]), free-margin plication (n = 271 [27%]) or resection (n = 75) or both, or annulus repair with resuspension (n = 230 [23%]), root reimplantation (n = 252 [25%]), or remodeling (n = 35 [3.5%]). Results: Planned repair was aborted for replacement in 115 patients (10%); risk factors included greater severity of aortic regurgitation (AR; p = 0.0002) and valve calcification (p < 0.0001). In-hospital outcomes for the remaining 1,009 patients included death (12 [1.2%]), stroke (13 [1.3%]), and reoperation for valve dysfunction (14 [1.4%]). Freedom from aortic valve reoperation at 1, 5, and 10 years was 97%, 93%, and 90%, respectively. Figure-of-8 suspension sutures, valve resuspension, and root repair and replacement were least likely to require reoperation; cusp repair with commissural sutures, plication, and commissuroplasty was most likely (p < 0.05). Survival at 1, 5, and 10 years was 96%, 92%, and 83%. Immediate postoperative AR grade was none-mild (94%), moderate (5%), and severe (1%). At 10 years after repair, AR grade was none (20%), mild (33%), moderate (26%), and severe (21%). Patients undergoing root procedures were less likely to have higher-grade postoperative AR (p < 0.0001). Conclusions: Valve repair is effective and durable for treating aortic valve dysfunction. Greater severity of AR preoperatively is associated with higher likelihood of repair failure. Commissural figure-of-8 suspension sutures and repair with annular support have the best long-term durability.",

author = "Ahmad Zeeshan and Idrees, {Jay J.} and Johnston, {Douglas R.} and Jeevanantham Rajeswaran and Roselli, {Eric E.} and Soltesz, {Edward G.} and Gillinov, {A. Marc} and Brian Griffin and Richard Grimm and Hammer, {Donald F.} and Pettersson, {G{\"o}sta B.} and Blackstone, {Eugene H.} and Sabik, {Joseph F.} and Svensson, {Lars G.}",

note = "Funding Information: This study was partly funded by the Gus P. Karos Registry Fund, the Reiman Foundation, the David Whitmire Hearst, Jr. Foundation, the Anderson Family Foundation, the Judith Dion Pyle Endowed Chair in Heart Valve Research, the John and Rosemary Brown Endowed Chair in Cardiovascular Medicine, the Peter and Elizabeth C. Tower and Family Endowed Chair in Cardiothoracic Research, and the Drs Sidney and Becca Fleischer Heart and Vascular Education Chair. Dr Svensson is an unpaid member of the executive committee for PARTNER trials I and II, chairman of the PARTNER Publication Committee, and an unpaid member of the executive committee of the COMMENCE (ProspeCtive, nOn-randoMized, MulticENter Clinical Evaluation of Edwards Pericardial Bioprostheses With a New Tissue Treatment Platform) trial, sponsored by Edwards Lifesciences. Publisher Copyright: {\textcopyright} 2018 The Society of Thoracic Surgeons",

year = "2018",

month = mar,

doi = "10.1016/j.athoracsur.2017.09.019",

language = "English (US)",

volume = "105",

pages = "739--748",

journal = "Annals of Thoracic Surgery",

issn = "0003-4975",

publisher = "Elsevier Inc.",

number = "3",

}

Zeeshan, A, Idrees, JJ, Johnston, DR, Rajeswaran, J, Roselli, EE, Soltesz, EG, Gillinov, AM, Griffin, B, Grimm, R, Hammer, DF, Pettersson, GB, Blackstone, EH, Sabik, JF & Svensson, LG 2018, 'Durability of Aortic Valve Cusp Repair With and Without Annular Support', Annals of Thoracic Surgery, vol. 105, no. 3, pp. 739-748. https://doi.org/10.1016/j.athoracsur.2017.09.019

TY - JOUR

T1 - Durability of Aortic Valve Cusp Repair With and Without Annular Support

AU - Zeeshan, Ahmad

AU - Idrees, Jay J.

AU - Johnston, Douglas R.

AU - Rajeswaran, Jeevanantham

AU - Roselli, Eric E.

AU - Soltesz, Edward G.

AU - Gillinov, A. Marc

AU - Griffin, Brian

AU - Grimm, Richard

AU - Hammer, Donald F.

AU - Pettersson, Gösta B.

AU - Blackstone, Eugene H.

AU - Sabik, Joseph F.

AU - Svensson, Lars G.

N1 - Funding Information: This study was partly funded by the Gus P. Karos Registry Fund, the Reiman Foundation, the David Whitmire Hearst, Jr. Foundation, the Anderson Family Foundation, the Judith Dion Pyle Endowed Chair in Heart Valve Research, the John and Rosemary Brown Endowed Chair in Cardiovascular Medicine, the Peter and Elizabeth C. Tower and Family Endowed Chair in Cardiothoracic Research, and the Drs Sidney and Becca Fleischer Heart and Vascular Education Chair. Dr Svensson is an unpaid member of the executive committee for PARTNER trials I and II, chairman of the PARTNER Publication Committee, and an unpaid member of the executive committee of the COMMENCE (ProspeCtive, nOn-randoMized, MulticENter Clinical Evaluation of Edwards Pericardial Bioprostheses With a New Tissue Treatment Platform) trial, sponsored by Edwards Lifesciences. Publisher Copyright: © 2018 The Society of Thoracic Surgeons

PY - 2018/3

Y1 - 2018/3

N2 - Background: To determine the value of aortic valve repair rather than replacement for valve dysfunction, we assessed late outcomes of various repair techniques in the contemporary era. Methods: From January 2001 to January 2011, aortic valve repair was planned in 1,124 patients. Techniques involved commissural figure-of-8 suspension sutures (n = 63 [6.2%]), cusp repair with commissuroplasty (n = 481 [48%]), debridement (n = 174 [17%]), free-margin plication (n = 271 [27%]) or resection (n = 75) or both, or annulus repair with resuspension (n = 230 [23%]), root reimplantation (n = 252 [25%]), or remodeling (n = 35 [3.5%]). Results: Planned repair was aborted for replacement in 115 patients (10%); risk factors included greater severity of aortic regurgitation (AR; p = 0.0002) and valve calcification (p < 0.0001). In-hospital outcomes for the remaining 1,009 patients included death (12 [1.2%]), stroke (13 [1.3%]), and reoperation for valve dysfunction (14 [1.4%]). Freedom from aortic valve reoperation at 1, 5, and 10 years was 97%, 93%, and 90%, respectively. Figure-of-8 suspension sutures, valve resuspension, and root repair and replacement were least likely to require reoperation; cusp repair with commissural sutures, plication, and commissuroplasty was most likely (p < 0.05). Survival at 1, 5, and 10 years was 96%, 92%, and 83%. Immediate postoperative AR grade was none-mild (94%), moderate (5%), and severe (1%). At 10 years after repair, AR grade was none (20%), mild (33%), moderate (26%), and severe (21%). Patients undergoing root procedures were less likely to have higher-grade postoperative AR (p < 0.0001). Conclusions: Valve repair is effective and durable for treating aortic valve dysfunction. Greater severity of AR preoperatively is associated with higher likelihood of repair failure. Commissural figure-of-8 suspension sutures and repair with annular support have the best long-term durability.

AB - Background: To determine the value of aortic valve repair rather than replacement for valve dysfunction, we assessed late outcomes of various repair techniques in the contemporary era. Methods: From January 2001 to January 2011, aortic valve repair was planned in 1,124 patients. Techniques involved commissural figure-of-8 suspension sutures (n = 63 [6.2%]), cusp repair with commissuroplasty (n = 481 [48%]), debridement (n = 174 [17%]), free-margin plication (n = 271 [27%]) or resection (n = 75) or both, or annulus repair with resuspension (n = 230 [23%]), root reimplantation (n = 252 [25%]), or remodeling (n = 35 [3.5%]). Results: Planned repair was aborted for replacement in 115 patients (10%); risk factors included greater severity of aortic regurgitation (AR; p = 0.0002) and valve calcification (p < 0.0001). In-hospital outcomes for the remaining 1,009 patients included death (12 [1.2%]), stroke (13 [1.3%]), and reoperation for valve dysfunction (14 [1.4%]). Freedom from aortic valve reoperation at 1, 5, and 10 years was 97%, 93%, and 90%, respectively. Figure-of-8 suspension sutures, valve resuspension, and root repair and replacement were least likely to require reoperation; cusp repair with commissural sutures, plication, and commissuroplasty was most likely (p < 0.05). Survival at 1, 5, and 10 years was 96%, 92%, and 83%. Immediate postoperative AR grade was none-mild (94%), moderate (5%), and severe (1%). At 10 years after repair, AR grade was none (20%), mild (33%), moderate (26%), and severe (21%). Patients undergoing root procedures were less likely to have higher-grade postoperative AR (p < 0.0001). Conclusions: Valve repair is effective and durable for treating aortic valve dysfunction. Greater severity of AR preoperatively is associated with higher likelihood of repair failure. Commissural figure-of-8 suspension sutures and repair with annular support have the best long-term durability.

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Durability of Aortic Valve Cusp Repair With and Without Annular Support

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