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Aortic Valve Repair 10 Years Results: Sub-groups Analysis
Andrea Mangini1, Monica Contino1, Claudia Romagnoni1, Massimo Lemma1, Paolo Vanelli1, Guido Gelpi1, Simone Colombo1,
Carlo Antona2.
1L sacco University Hospital, Milano, Italy, 2Università degli Studi di Milano, Milano, Italy.

OBJECTIVE: In the last 20 years Aortic Valve Repair (AVR) has undergone a remarkable development so that now it represent an attractive alternative to aortic valve replacement; this process was due to a better comprehension of aortic root anatomy and of the pathogenetic mechanisms at the base of the aortic regurgitation. Now that AVR techniques have reached a good standardization level, we want to analyze our medium and long term results in relation to aortic regurgitation mechanism and different repair techniques adopted.
METHODS: From January 2003 to January 2013 we treated 218 patients affected by aortic valve regurgitation caused by leaflets pathology (prolapse, fibrosis or retraction) or root dilatation with a combination of the principal leaflet repair techniques and, when necessary, sparing procedures. Follow-up was achieved with periodic echocardiograms and clinical evaluations. We evaluated by means of Kaplan -Meier analysis the results in different subgroups of patients.
RESULTS: Freedom for AR>2 in patients with normal (<25mm) virtual basal ring (VBR) was 92.5±3.3% while in patient with dilated VBR (>25mm) was 95.2±3.3% (p=0.97). To analyse more clinically significant aspects of AVR, we clustered techniques to evaluate the most common and simple repair procedures: the functional aortic annulus (FAA) repair with replacement of the ascending aorta, or STJ plasty, associated to interleaflets triangles reshaping compared to complex procedures defined as an association of different techniques with or without sparing procedures. In this setting freedom from AR>2 was 98.0 ± 1.9% for the simple procedures vs 90.1 ± 4.1% for complex procedures, (p=0.15). Freedom from AR >2 in FAA repair with normal VBR (<25mm) was 100% while in patient with dilated VBR (>25mm) was 90.0 ± 9.5% (p=0.04). We analysed freedom from AR>2 in patients in which leaflets were repaired (plication, triangle resection or shaving): 89.5 ± 4.4% compared to not touched 98.2 ± 1.8% (p=0.11).
CONCLUSIONS: All AVR techniques show good long term results if correctly selected in consideration of the native valve regurgitation mechanism. Surgical procedures involving significantly dilated VBR and/or important leaflets impairment are more challenging, but results are still satisfying.

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