Aortic valve repair – a 10-year experience in Dubrava University Hospital

    Authors

    Keywords

    aortic root, valve repair

    DOI

    https://doi.org/10.15836/ccar2024.465

    Full Text

    **Introduction**: The aortic root is a complex structure connecting the heart to systemic circulation that ensures intermittent, unidirectional channeling of large volumes of fluid while maintaining minimal resistance, and the least possible tissue stress during varying hemodynamic demands. When any component of the aortic root fails, the intricacy of this structure highlights the importance of reparative surgical techniques that preserve its functionality and anatomy (1). Continuing research in this field is leading to improved surgical techniques with the goal of aortic valve repair becoming the new standard for patients suffering from AI and/or aortic root dilatation (2). We report our 10-year experience with adult aortic valve repair. **Patients and Methods**: Between 2014 and 2024, a total of 180 patients with AI with/without aortic root dilatation underwent aortic valve repair performed by a single surgeon. All the patients were included in the AVIATOR database and the transthoracic echocardiography examinations were reported during follow-up period. **Results**: In baseline characteristics, mean age was 50.8±13.5 years and 82.7% of patients were males. Regarding the number of leaflets, majority of patients were in TAV group (52%), with 3% quadricuspid and 1% unicuspid. BAV patients were significantly younger, with narrower roots at the level of SV and STJ. No other major differences were observed. There were no deaths during the hospital stay and 7 patients died in the follow-up period with none of the deaths cardiac- related. Intraoperative conversion to valve replacement due to insufficient repair was necessary in 7 patients. Overall, 10 patients required reoperation – 3 in the early postoperative period and 7 in the later phases, resulting in a freedom from reoperation rate of 94.2% at 10 years. **Conclusion**: Valve-sparing aortic root surgery is both challenging and demanding, yet it offers remarkable rewards, yielding excellent outcomes when approached with systematic methodology. External annuloplasty is recognized as the most physiological technique and has become a vital component of aortic valve repair (3). With continuous advancements in surgical techniques and personalized strategies for each patient, we can achieve excellent repair durability and a high rate of freedom from valve-related complications.

    Literature

    1. Charitos EI, Sievers HH. Anatomy of the aortic root: implications for valve-sparing surgery. Ann Cardiothorac Surg. 2013 January;2(1):53–6. https://doi.org/10.3978/j.issn.2225-319x.2012.11.18
    2. Arabkhani B, Mookhoek A, Di Centa I, Lansac E, Bekkers JA, De Lind Van Wijngaarden R, et al. Reported Outcome After Valve-Sparing Aortic Root Replacement for Aortic Root Aneurysm: A Systematic Review and Meta-Analysis. Ann Thorac Surg. 2015 September;100(3):1126–31. https://doi.org/10.1016/j.athoracsur.2015.05.093
    3. Lansac E, Di Centa I, Varnous S, Rama A, Jault F, Duran CM, et al. External aortic annuloplasty ring for valve-sparing procedures. Ann Thorac Surg. 2005 January;79(1):356–8. https://doi.org/10.1016/j.athoracsur.2003.10.103
    Cardiologia Croatica
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    Aortic valve repair – a 10-year experience in Dubrava University Hospital

    Extended Abstract
    Issue11-12
    Published
    Pages465
    PDF via DOIhttps://doi.org/10.15836/ccar2024.465
    aortic root
    valve repair

    Authors

    Nikola SliškovićORCIDDubrava University Hospital, Zagreb, Croatia
    Gloria ŠestanORCIDDubrava University Hospital, Zagreb, Croatia
    Davor BarićORCIDDubrava University Hospital, Zagreb, Croatia
    Daniel UnićORCIDDubrava University Hospital, Zagreb, Croatia
    Josip VarvodićORCIDDubrava University Hospital, Zagreb, Croatia
    Marko KušurinORCIDDubrava University Hospital, Zagreb, Croatia
    Savica GjorgjievskaORCIDDubrava University Hospital, Zagreb, Croatia
    Ivana JurinORCIDDubrava University Hospital, Zagreb, Croatia
    Danijela GrizeljORCIDDubrava University Hospital, Zagreb, Croatia
    Dubravka ŠušnjarORCIDDubrava University Hospital, Zagreb, Croatia
    Zrinka Šafarić OremušORCIDDubrava University Hospital, Zagreb, Croatia
    Nikola BuljORCIDUniversity Hospital Centre “Sestre milosrdnice”, Zagreb, Croatia
    Igor Rudež*ORCIDDubrava University Hospital, Zagreb, Croatia

    *Correspondence email: rudi@kbd.hr

    Full Text

    Introduction: The aortic root is a complex structure connecting the heart to systemic circulation that ensures intermittent, unidirectional channeling of large volumes of fluid while maintaining minimal resistance, and the least possible tissue stress during varying hemodynamic demands. When any component of the aortic root fails, the intricacy of this structure highlights the importance of reparative surgical techniques that preserve its functionality and anatomy (1). Continuing research in this field is leading to improved surgical techniques with the goal of aortic valve repair becoming the new standard for patients suffering from AI and/or aortic root dilatation (2). We report our 10-year experience with adult aortic valve repair.

    Patients and Methods: Between 2014 and 2024, a total of 180 patients with AI with/without aortic root dilatation underwent aortic valve repair performed by a single surgeon. All the patients were included in the AVIATOR database and the transthoracic echocardiography examinations were reported during follow-up period.

    Results: In baseline characteristics, mean age was 50.8±13.5 years and 82.7% of patients were males. Regarding the number of leaflets, majority of patients were in TAV group (52%), with 3% quadricuspid and 1% unicuspid. BAV patients were significantly younger, with narrower roots at the level of SV and STJ. No other major differences were observed. There were no deaths during the hospital stay and 7 patients died in the follow-up period with none of the deaths cardiac- related. Intraoperative conversion to valve replacement due to insufficient repair was necessary in 7 patients. Overall, 10 patients required reoperation – 3 in the early postoperative period and 7 in the later phases, resulting in a freedom from reoperation rate of 94.2% at 10 years.

    Conclusion: Valve-sparing aortic root surgery is both challenging and demanding, yet it offers remarkable rewards, yielding excellent outcomes when approached with systematic methodology. External annuloplasty is recognized as the most physiological technique and has become a vital component of aortic valve repair (3). With continuous advancements in surgical techniques and personalized strategies for each patient, we can achieve excellent repair durability and a high rate of freedom from valve-related complications.

    Literature

    1. 1.
      Charitos EI, Sievers HH. Anatomy of the aortic root: implications for valve-sparing surgery. Ann Cardiothorac Surg. 2013 January;2(1):53–6.DOI
    2. 2.
      Arabkhani B, Mookhoek A, Di Centa I, Lansac E, Bekkers JA, De Lind Van Wijngaarden R, et al. Reported Outcome After Valve-Sparing Aortic Root Replacement for Aortic Root Aneurysm: A Systematic Review and Meta-Analysis. Ann Thorac Surg. 2015 September;100(3):1126–31.DOI
    3. 3.
      Lansac E, Di Centa I, Varnous S, Rama A, Jault F, Duran CM, et al. External aortic annuloplasty ring for valve-sparing procedures. Ann Thorac Surg. 2005 January;79(1):356–8.DOI