Aortic Valve Reimplantation in Patients with Connective Tissue Disorders: Are the Leaflets Durable?
Lars G. Svensson1, Patrick R. Vargo1, Milind Desai2, Vidyasagar Kalahasti2, Brian Griffin2, Eric E. Roselli1, Jeevanantham Rajeswaran1, Eugene Blackstone1
1Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, United States, 2Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, United States
Objective: The durability of reimplanted myxomatous aortic valves in root replacements for patients with connective tissue disorders (CTD) is unclear; therefore, we sought to evaluate the long-term resilience of these repairs.
Methods: From January 1980 to January 2020, there were 214 elective, primary aortic valve reimplantation operations in patients diagnosed with CTD and 645 with non-CTD. The CTD cohort included 164 (77%) patients diagnosed with Marfan, 7 (3.3%) Ehlers-Danlos, and 23 (11%) Loeys-Dietz. We accounted for differing patient characteristics between the two groups by propensity-score matching to compare outcomes, yielding 96 matched pairs. Longitudinal echocardiographic measures were compared using non-linear mixed effects models.
Results: In the CTD cohort, there were no operative moralities (30-day or in-hospital), 1 (0.47%) stroke, and 1 (0.47%) early in-hospital reoperation for valve dysfunction. Ten-year prevalence of no aortic regurgitation was 86%, mild 11%, and moderate 3%. Ten-year freedom from reoperation in the CTD cohort was 97% (vs 93.3% in non-CTD). In propensity-matched cohorts, there were no significant differences in in-hospital outcomes, longitudinal aortic regurgitation and mean gradient, risk of reoperation on the aortic valve (Figure), or risk of late death.
Conclusions: Aortic valve reimplantation is a durable operation in patients with CTD and root aneurysms. These patients do not experience early degeneration of their reimplanted aortic valves.
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