Aortic valve cusp repair does not affect durability of modified aortic valve reimplantation for tricuspid aortic valvesCentral MessagePerspective
Kevin Hodges, MD,
Bradley F. Rosinski, MD,
Eric E. Roselli, MD,
Jeevanantham Rajeswaran, PhD,
Brian Griffin, MD,
Patrick R. Vargo, MD,
Marijan Koprivanac, MD,
Michael Tong, MD,
Eugene H. Blackstone, MD,
Lars G. Svensson, MD, PhD
Affiliations
Kevin Hodges, MD
Department of Thoracic and Cardiovascular Surgery, Aortic Valve Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
Bradley F. Rosinski, MD
Department of Thoracic and Cardiovascular Surgery, Aortic Valve Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
Eric E. Roselli, MD
Department of Thoracic and Cardiovascular Surgery, Aortic Valve Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
Jeevanantham Rajeswaran, PhD
Department of Quantitative Health Science, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
Brian Griffin, MD
Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
Patrick R. Vargo, MD
Department of Thoracic and Cardiovascular Surgery, Aortic Valve Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
Marijan Koprivanac, MD
Department of Thoracic and Cardiovascular Surgery, Aortic Valve Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
Michael Tong, MD
Department of Thoracic and Cardiovascular Surgery, Aortic Valve Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
Eugene H. Blackstone, MD
Department of Thoracic and Cardiovascular Surgery, Aortic Valve Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Science, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio
Lars G. Svensson, MD, PhD
Department of Thoracic and Cardiovascular Surgery, Aortic Valve Center, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio; Address for reprints: Lars G. Svensson, MD, PhD, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, 9500 Euclid Ave, Desk J1-227, Cleveland, OH 44195.
Objective: During aortic valve reimplantation, cusp repair may be needed to produce a competent valve. We investigated whether the need for aortic valve cusp repair affects aortic valve reimplantation durability. Methods: Patients with tricuspid aortic valves who underwent aortic valve reimplantation from January 2002 to January 2020 at a single center were retrospectively analyzed. Propensity matching was used to compare outcomes between patients who did and did not require aortic valve cusp repair. Results: Cusp repair was performed in 181 of 756 patients (24%). Patients who required cusp repair were more often male, were older, had more aortic valve regurgitation, and less often had connective tissue disease. Patients who underwent cusp repair had longer aortic clamp time (124 ± 43 minutes vs 107 ± 36 minutes, P = .001). In-hospital outcomes were similar between groups and with no operative deaths. A total of 98.3% of patients with cusp repair and 99.3% of patients without cusp repair had mild or less aortic regurgitation at discharge. The median follow-up was 3.9 and 3.2 years for the cusp repair and no cusp repair groups, respectively. At 10 years, estimated prevalence of moderate or more aortic regurgitation was 12% for patients with cusp repair and 7.0% for patients without cusp repair (P = .30). Mean aortic valve gradients were 6.2 mm Hg and 8.0 mm Hg, respectively (P = .01). Ten-year freedom from reoperation was 99% versus 99% (P = .64) in the matched cohort and 97% versus 97%, respectively (P = .30), in the unmatched cohort. Survival at 10 years was 98% after cusp repair and 93% without cusp repair (P = .05). Conclusions: Aortic valve reimplantation for patients with tricuspid aortic valves has excellent long-term results. Need for aortic valve cusp repair does not affect long-term outcomes and should not deter surgeons from performing valve-sparing surgery.
