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Outcome comparison of different approaches to aortic root aneurysm.
Gocol, Radoslaw; Bis, Jaroslaw; Malinowski, Marcin; Morkisz, Lukasz; Jodlowski, Mikolaj; Darocha, Tomasz; Ciosek, Joanna; Wojakowski, Wojciech; Deja, Marek A.
Afiliación
  • Gocol R; Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland. mdeja@sum.edu.pl.
  • Bis J; Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland.
  • Malinowski M; Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland.
  • Morkisz L; Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland.
  • Jodlowski M; Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland.
  • Darocha T; Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland.
  • Ciosek J; Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland.
  • Wojakowski W; Department of Anesthesiology and Intensive Care, Medical University of Silesia, Poland.
  • Deja MA; 3rd Division of Cardiology and Structural Heart Diseases, Upper-Silesian Heart Center, Katowice, Poland.
Kardiol Pol ; 80(4): 436-444, 2022.
Article en En | MEDLINE | ID: mdl-35152397
BACKGROUND: The treatment of aortic root aneurysm remains challenging for both cardiac surgeons and cardiologists. AIMS: This study aimed to assess and compare the long-term outcomes of different approaches to aortic root replacement (ARR). METHODS: All elective patients operated for aortic root aneurysm with or without aortic regurgitation at our institution over a 10-year period were included. We excluded patients with any degree of aortic stenosis and with active endocarditis. We assessed mortality, freedom from reoperation, freedom from aortic valve regurgitation, and the rate of hemorrhagic and thromboembolic complications. RESULTS: Two hundred and four patients underwent elective aortic root replacement: 107 (53%) valve-sparing aortic root replacement (VSARR), 35 (17%) mechanical Bentall procedure (MB), and 62 (30%) Bio-Bentall procedure (BB). Early mortality for VSARR, BB, and MB group was 2.8%, 4.8%, and 0%, respectively (P = 0.40). Estimated 5-year survival was: 90.2% vs. 78.4% vs. 94.2%, respectively (P = 0.12), 5-year freedom from reoperation: 97.8%, 96.6%, and 96.8%, respectively (P = 0.99). Estimat-ed 5-year freedom from complications was: 94.2%, 83.1% and 57.3% in the VSARR, BB and MB group, respectively (P <0.001). On last follow-up echocardiography, 90.5%, 98.4%, and 97.1% (P = 0.08) of patients were free from aortic regurgitation grade 2 or higher. The median (IQR) aortic valve peak gradient was 9 (6-12) mm Hg, 12 (10-18) mm Hg and 16 (14-22) mm Hg, respectively (P <0.001). Complications were predicted by mechanical Bentall (hazard ratio, 6.70 [2.54-17.63]; P <0.001). CONCLUSION: With the same mortality, freedom from reoperation, and a minimal late complication rate in comparison with mechanical Bentall and Bio-Bentall, VSARR might be the preferred approach to aortic root aneurysm.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Insuficiencia de la Válvula Aórtica / Aneurisma de la Aorta Torácica / Implantación de Prótesis de Válvulas Cardíacas Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Kardiol Pol Año: 2022 Tipo del documento: Article País de afiliación: Polonia Pais de publicación: Polonia

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Insuficiencia de la Válvula Aórtica / Aneurisma de la Aorta Torácica / Implantación de Prótesis de Válvulas Cardíacas Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Kardiol Pol Año: 2022 Tipo del documento: Article País de afiliación: Polonia Pais de publicación: Polonia