The influence of Marfans and bicuspid valves on outcomes following aortic valve reimplantation

J Card Surg. 2017 Oct;32(10):604-612. doi: 10.1111/jocs.13206. Epub 2017 Sep 20.

Abstract

Background: We analyzed our early and midterm results with aortic valve reimplantation surgery to determine the influence of Marfan syndrome and bicuspid valves on outcomes with this technique.

Methods: Between March 2004 and December 2015, 267 patients underwent aortic valve reimplantation operations. The mean diameter of the sinuses of Valsalva was 50 ± 3 mm and moderate/severe aortic regurgitation was present in 34.4% of these patients. A bicuspid aortic valve was present in 21% and 40% had Marfan syndrome.

Results: Overall 30-day mortality was 0.37% (1/267). Mean follow-up was 59.7 ± 38.7 months. Overall survival at 1, 3, and 5 years was 98 ± 8%, 98 ± 1%, and 94 ± 2%, respectively. Freedom from reoperation and aortic regurgitation >II was 99 ± 5%, 98 ± 8%, 96.7 ± 8%, and 99 ± 6%, 98 ± 1%, 98 ± 1%, respectively at 1, 3, and 5 years follow-up, with no differences between Marfan and bicuspid aortic valve groups. (p = 0.94 and p = 0.96, respectively). No endocarditis or thromboembolic complications were documented, and 93.6% of the patients did not receive any anticoagulation therapy.

Conclusions: The reimplantation technique for aortic root aneurysms is associated with excellent clinical and functional outcomes at short and mid-term follow-up.

Keywords: Bicuspid aortic valve; Marfan syndrome; aortic regurgitation; aortic root repair; aortic valve repair; aortic valve sparing surgery.

MeSH terms

  • Adult
  • Aftercare
  • Aged
  • Aortic Aneurysm / etiology*
  • Aortic Aneurysm / mortality
  • Aortic Aneurysm / surgery*
  • Aortic Valve / abnormalities*
  • Aortic Valve / surgery*
  • Aortic Valve Insufficiency / etiology
  • Bicuspid Aortic Valve Disease
  • Female
  • Heart Valve Diseases / complications*
  • Heart Valve Prosthesis Implantation / methods*
  • Heart Valve Prosthesis Implantation / mortality
  • Humans
  • Male
  • Marfan Syndrome / complications*
  • Middle Aged
  • Organ Sparing Treatments / methods*
  • Retrospective Studies
  • Sinus of Valsalva / pathology
  • Time Factors
  • Treatment Outcome