Reduction aortoplasty: safe and durable treatment for borderline dilatation in selected patients.

Détails

ID Serval
serval:BIB_2E04607D79F1
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Reduction aortoplasty: safe and durable treatment for borderline dilatation in selected patients.
Périodique
Journal of Heart Valve Disease
Auteur⸱e⸱s
Niclauss L., Delay D., Ruchat P., von Segesser L.K.
ISSN
0966-8519 (Print)
ISSN-L
0966-8519
Statut éditorial
Publié
Date de publication
2012
Peer-reviewed
Oui
Volume
21
Numéro
5
Pages
584-590
Langue
anglais
Notes
Publication types: Journal Article
Publication Status: ppublish
Résumé
BACKGROUND AND AIM OF THE STUDY: In aortic valve surgery, the management of ascending aortic dilatation is not clearly defined. Guidelines recommend replacement at diameters of 50 mm, but the handling of borderline dilatation has not been detailed. Reduction aortoplasty has been proposed as a less invasive and safe option in the case of a smaller dilatation above the sinotubular junction.
METHODS: Between 1999 and 2009, reduction aortoplasties with or without external reinforcement associated with aortic valve surgery were performed in 82 patients. The ascending aortic diameter was measured echocardiographically at a mean follow up (FU) of 32 months (FU was 91% complete).
RESULTS: The in-hospital mortality was 1.2%, and all patients were in NYHA class I or II. Echocardiography revealed a re-dilatation (> or = 5 mm) rate of 5.5%. One patient required reoperation. At univariate analysis, a preoperative dilatation >45 mm, persistent postoperative diameters >35 mm after reduction, and a younger age at the time of surgery (<65 years) were significant risk factors. Multivariate analysis confirmed the parameters for re-dilatation, and the area under the receiver operating curve was 0.85 for these three criteria. Mesh implantation, FU duration and bicuspid valve had no significant impact on outcome.
CONCLUSION: Reduction aortoplasty is a less-invasive option to handle borderline supra-coronary aneurysms in the case of concomitant valve surgery, compared to aortic replacement. The mortality remained low, and equal to that for simple aortic valve replacement. A large preoperative aortic diameter and age < or = 65 years favored re-dilatation. Correct downsizing was technically demanding, but indispensable for long-term stabilization. Regard for these criteria could lead to numerous patients benefiting from this operative strategy, with good results.
Mots-clé
Adult, Aged, Aged, 80 and over, Aorta/surgery, Aortic Aneurysm/pathology, Aortic Aneurysm/surgery, Aortic Diseases/pathology, Aortic Diseases/surgery, Cardiovascular Surgical Procedures, Dilatation, Pathologic/pathology, Dilatation, Pathologic/surgery, Echocardiography, Female, Humans, Male, Middle Aged, Patient Selection, Postoperative Period, Recurrence, Retrospective Studies, Risk Factors, Treatment Outcome
Pubmed
Web of science
Création de la notice
28/01/2008 9:34
Dernière modification de la notice
20/08/2019 14:12
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