Please use this identifier to cite or link to this item: doi:10.22028/D291-39829
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Title: Long-term Results of Differentiated Anatomic Reconstruction of Bicuspid Aortic Valves
Author(s): Schneider, Ulrich
Hofmann, Christopher
Schöpe, Jakob
Niewald, Ann-Kristin
Giebels, Christian
Karliova, Irem
Schäfers, Hans-Joachim
Language: English
Title: JAMA cardiology
Volume: 5
Issue: 12
Pages: 1366–1373
Publisher/Platform: American Medical Association
Year of Publication: 2020
DDC notations: 610 Medicine and health
Publikation type: Journal Article
Abstract: Bicuspid aortic valve (BAV) repair has been used in limited cohorts, but its long-term results in a large population are unknown. To analyze the long-term stability of BAV repair for survival and the factors associated with repair failure and to evaluate whether a differentiated anatomic repair approach may improve repair stability. In this case series, 1024 patients underwent BAV repair for aortic regurgitation or aneurysm between October 1995 and June 2018, with a mean (SD) follow-up time of 56 (49) months and maximum follow-up of 271 months. Systematic modifications in technique based on anatomic principles were introduced in 2009 and applied for the last 727 patients. Data were acquired prospectively and analyzed retrospectively. Repair of BAV with or without concomitant aortic replacement, as well as postoperative clinical and echocardiographic follow-up. Survival and incidence of reoperation or recurrent aortic regurgitation, as well as factors associated with valve repair failure. Among the 1024 patients in the study (920 male [89.8%]; mean [SD] age, 47 [13] years [range, 15-86 years]), the survival rate at 15 years was 82.1%. The cumulative incidence of reoperation was 30.7% (95% CI, 22.7%-38.7%) at 15 years. Cusp calcification (subdistribution hazard ratio, 1.78; 95% CI, 1.14-2.77; P = .01), asymmetric commissural orientation (subdistribution hazard ratio, 1.95; 95% CI, 1.02-3.72; P = .04), and use of a pericardial patch for cusp repair (subdistribution hazard ratio, 5.25; 95% CI, 3.52-7.82; P < .001) were associated with time to reoperation. At 10 years, the incidence of reoperation was significantly reduced among patients who received the anatomic repair concept compared with those who had undergone surgery in the earlier period (8.8% vs 24.6%; P < .001). This study suggests that survival after BAV repair is excellent and that a large proportion of BAV repairs will remain stable. Repair stability can be markedly improved by an anatomic repair concept. Cusp calcification and the need for cusp repair using a patch remain the factors most strongly associated with valve failure. In those instances, valve replacement should be preferred.
DOI of the first publication: 10.1001/jamacardio.2020.3749
URL of the first publication:
Link to this record: urn:nbn:de:bsz:291--ds-398297
ISSN: 2380-6583
Date of registration: 23-May-2023
Faculty: M - Medizinische Fakultät
Department: M - Chirurgie
M - Medizinische Biometrie, Epidemiologie und medizinische Informatik
Professorship: M - Prof. Dr. Hans Joachim Schäfers
M - Prof. Dr. Stefan Wagenpfeil
Collections:SciDok - Der Wissenschaftsserver der Universität des Saarlandes

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