Residual and Progressive Aortic Regurgitation After Valve-Sparing Root Replacement: A Propensity-Matched Multi-Institutional Analysis in 764 Patients

• Published in: The Annals of thoracic surgery Vol. 101; no. 4; pp. 1500 - 1506
• Main Authors: Kari, Fabian A., MD, Doll, Kai-Nicolas, MD, Hemmer, Wolfgang, MD, Liebrich, Markus, MD, Sievers, Hans-Hinrich, MD, Richardt, Doreen, MD, Reichenspurner, Hermann, MD, Detter, Christian, MD, Siepe, Matthias, MD, Czerny, Martin, MD, Beyersdorf, Friedhelm, MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01.04.2016
• Subjects: Adult; Aged; Aorta, Thoracic - surgery; Aortic Valve - surgery; Aortic Valve Insufficiency - diagnostic imaging; Aortic Valve Insufficiency - mortality; Aortic Valve Insufficiency - surgery; Blood Vessel Prosthesis Implantation - adverse effects; Blood Vessel Prosthesis Implantation - methods; Cardiac Valve Annuloplasty - methods; Cardiothoracic Surgery; Case-Control Studies; Disease Progression; Echocardiography - methods; Female; Follow-Up Studies; Germany; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Humans; Logistic Models; Male; Middle Aged; Multivariate Analysis; Organ Sparing Treatments - methods; Propensity Score; Recurrence; Reoperation - methods; Replantation - methods; Retrospective Studies; Risk Assessment; Severity of Illness Index; Statistics, Nonparametric; Surgery; Survival Rate; Treatment Outcome
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2015.10.002

Background Residual/progressive aortic regurgitation (rAR, pAR) after valve-sparing aortic root replacement (V-SARR) can lead to reoperations. We sought to characterize risk factors of mild rAR and pAR after V-SARR in a multicenter cohort. The effect of additional cusp repair on valve function was analyzed using propensity matching. Methods A total of 1,015 patients after V-SARR were identified with (n = 288, 28%) or without additional cusp/commissure repair (n = 727, 72%) at four cardiac units in Germany. A total of 764 patients fulfilling transthoracic echocardiography follow-up-criteria comprised the study cohort. Logistic regression was used for risk factor analysis with endpoints rAR, new onset AR, and pAR. t tests and analyses of variance were used for between-group differences. The effects of additional cusp repair on valve function were studied comparing propensity-matched quintiles. Results The incidence of rAR was 29%, with influencing factors aneurysm size ( p = 0.07) and preoperative aortic valve function ( p = 0.08). It was found more often among nonsyndromic patients (34% vs. 14%; OR, 0.4; p < 0.001). Progression of rAR was detectable in 30% after a mean of 4.3 years. The progression rate of rAR ∼0.3 grades per patient-year within the first 5 years. When quintiles identified by propensity score were compared, additional cusp repair was linked to new onset AR ( p = 0.016) while it was not linked to rAR ( p = 0.14) or pAR ( p = 0.5). Conclusions The incidences of rAR and pAR are considerable after V-SARR. Patients should be operated on before large aneurysms are present. New onset AR after an initially good functional result is more likely after an additional cusp repair, while rAR and pAR are not influenced by cusp repair.