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10 years Outcomes of 200 Patients after Aortic Valve Repair
Marek Jasiński, Radoslaw Gocol, Marcin malinowski, Damian Hudziak, Marek Deja.
Medical University of Silesia, Katowice, Poland.

Objectives: Advantages of aortic valve repair and root reconstruction include maintenance of natural valve hemodynamics and avoidance of prosthetic valve-related complications. However, general acceptance of valve reconstruction currently may be limited by paucity of long-term follow-up data from only a few centers. This report is intended to supplement existing outcome information for aortic valve repair.
Methods: Between 2003 and 2013, 200 consecutive patients (149 male, 51 female, mean age 53.1 years) with significant aortic regurgitation and aortic root enlargement underwent aortic valve repair and associated root reconstruction. The same prospective selection criteria and systematic valve repair approaches were followed throughout the study. Root management consisted of either root remodeling or reimplantation with Dacron prostheses. Kaplan-Meier techniques assessed major end points of all-cause mortality, reoperation, and repair failure. Univariable log-rank testing identified associations between risk factors and major events.
Results: Early mortality was 2% (4 patients), and early repair failure was 2,5% (5 patients). NYHA Class was found to be a risk factor for early mortality (UOM) and morbidity ( OR 3.3- p=0.03), whereas cross clamp time and cardiopulmonary time were risk factors for early mortality : OR- 1,04[1;1,07]-p=0.01 and OR- 1,02 [1;1,03]- p=0.02 , respectively. Survival at a mean followup of 48.6 +/- 34.3 (SD) months (median follow up = 43.6 [17,8;78] months) was 93%,with a freedom from reoperation of 91%
. Univariable risk factors for mortality were: preoperative NYHA class and requirement for root replacement. Repair failure and reoperation were associated with bicuspid valve anatomy, subcommissural annuloplasty, leaflet resection with pericardial patching, and Gore-Tex leaflet reinforcement. Valve related redooperation was adversely associated with reimplantation with Valsalva graft modification.
Conclusions: Data from a prospective cohort of patients undergoing aortic valve repair and root reconstruction reinforce the satisfactory late results obtained with valve reconstruction. These findings suggest broader application of aortic valve repair in future patients.

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