Aortic valve preservation in acute type A dissection: is it sound?

Détails

ID Serval
serval:BIB_0D6ECDCB706A
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Aortic valve preservation in acute type A dissection: is it sound?
Périodique
Journal of Thoracic and Cardiovascular Surgery
Auteur(s)
von Segesser  L. K., Lorenzetti  E., Lachat  M., Niederhauser  U., Schonbeck  M., Vogt  P. R., Turina  M. I.
ISSN
0022-5223
Statut éditorial
Publié
Date de publication
02/1996
Peer-reviewed
Oui
Volume
111
Numéro
2
Pages
381-90; discussion 390-1
Notes
Clinical Trial
Journal Article --- Old month value: Feb
Résumé
A series of 200 consecutive patients with acute Stanford type A dissection (157 men, 78%; 43 women, 22%) was analyzed to assess the validity of aortic valve preservation or repair. Indication for the operation in most cases was based on echocardiographic examination alone, to reduce the delay. In the majority of patients (111/200, 56%) the aortic valve was preserved or repaired if necessary. Aortic root replacement with a composite graft was performed in 66 of 200 patients (33%), mainly because of an enlarged aortic anulus and sinus. Replacement of the aortic valve and the supracoronary ascending aorta was performed in 23 of 200 patients (12%) with a diseased aortic valve (e.g., bicuspid valve) but an acceptable aortic sinus. Follow-up totaled 656 patient-years (maximum 14 years). Actuarial analyses as a function of type of repair and type of aortic valve provided the following probabilities plus or minus errors (95%): overall survival of the 200 patients was 78.3% +/- 2.9% after 30 days, 74.95% +/- 3.1% after 1 year, 67.9% +/- 3.6% after 5 years, and 48.5% +/- 6.1% after 10 years. Actuarial probability of freedom from reoperation for valve failure in the complete series was calculated as 100.0% +/- 0.0% after 30 days, 99.3% +/- 0.7% after 1 year, 97.5% +/- 1.5% after 5 years, and 95.1% +/- 2.8% after 10 years. During long-term follow-up, there was no significant difference among groups with regard to structural deterioration, valve thrombosis, thromboembolic complications, anticoagulant-induced hemorrhage, and endocarditis. Freedom from valve failure and valve-related complications are similar for preserved, repaired, mechanical, and biologic valves. Valve-related reoperations are rare during at least 5 years of follow-up. Hence preservation or repair of the aortic valve can be recommended in the majority of patients with acute type A dissection.
Mots-clé
Actuarial Analysis Acute Disease Adolescent Adult Aged Aneurysm, Dissecting/mortality/*surgery Aortic Aneurysm/mortality/*surgery Aortic Valve/*surgery Female Humans Male Middle Aged Survival Rate Vascular Surgical Procedures/methods
Pubmed
Web of science
Open Access
Oui
Création de la notice
14/02/2008 15:15
Dernière modification de la notice
20/08/2019 13:34
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