Congenital heart disease · 2016
Bicuspid and Unicuspid Aortic Valve: Fate of Moderate/Severe Mixed Aortic Valve Disease.
СтатьяНазвание и аннотация: Перевод в очереди
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Egbe Alexander C, Connolly Heidi M, Poterucha Joseph T, Warnes Carole A
Аннотация
OBJECTIVES: There is a paucity of data about mixed aortic valve disease (MAVD) in patients with bicuspid/unicuspid aortic valve (BAV). This study sought to describe the outcomes of patients with moderate/severe MAVD.
METHODS: We queried our database for patients with BAV and moderate/severe MAVD seen between 1994 and 2013. We excluded patients with baseline New York Heart Association (NYHA) III/IV symptoms, left ventricular ejection fraction <50%, aortic dimension >50 mm, and significant disease of other valves. The purpose of the study was to determine the freedom from NYHA III/IV symptoms and aortic valve replacement (AVR).
RESULTS: We identified 138 patients with moderate/severe MAVD; mean age was 51 ± 12 years; 112 (81%) were males; and follow-up was 8.5 ± 4 years. Ninety-two patients (67%) underwent AVR within 3.7 ± 2.5 years. Mechanical prostheses were implanted in 73 patients (79%); 22 patients (26%) and 36 patients (39%) had concomitant coronary artery bypass graft and aorta replacement during AVR respectively. There were no surgical deaths. Freedom from AVR was 84%, 51%, and 20% at 1, 5 and 10 years respectively. Predictors of AVR were age at presentation (hazard ratio [HR] 5.22; confidence interval [CI] 3.10 to 6.64) for every decade increase in age; and having severe stenosis or regurgitation at the time of presentation (HR 1.32; CI 1.05 to 3.16).
CONCLUSIONS: Age and disease severity should be incorporated in the risk assessment of BAV patients with MAVD, and patients with both risk factors should be monitored closely.
METHODS: We queried our database for patients with BAV and moderate/severe MAVD seen between 1994 and 2013. We excluded patients with baseline New York Heart Association (NYHA) III/IV symptoms, left ventricular ejection fraction <50%, aortic dimension >50 mm, and significant disease of other valves. The purpose of the study was to determine the freedom from NYHA III/IV symptoms and aortic valve replacement (AVR).
RESULTS: We identified 138 patients with moderate/severe MAVD; mean age was 51 ± 12 years; 112 (81%) were males; and follow-up was 8.5 ± 4 years. Ninety-two patients (67%) underwent AVR within 3.7 ± 2.5 years. Mechanical prostheses were implanted in 73 patients (79%); 22 patients (26%) and 36 patients (39%) had concomitant coronary artery bypass graft and aorta replacement during AVR respectively. There were no surgical deaths. Freedom from AVR was 84%, 51%, and 20% at 1, 5 and 10 years respectively. Predictors of AVR were age at presentation (hazard ratio [HR] 5.22; confidence interval [CI] 3.10 to 6.64) for every decade increase in age; and having severe stenosis or regurgitation at the time of presentation (HR 1.32; CI 1.05 to 3.16).
CONCLUSIONS: Age and disease severity should be incorporated in the risk assessment of BAV patients with MAVD, and patients with both risk factors should be monitored closely.
Предметные рубрики MeSH
AdultAge FactorsAgedAortic ValveAortic Valve InsufficiencyAortic Valve StenosisBicuspid Aortic Valve DiseaseDatabases, FactualDisease-Free SurvivalFemaleHeart Valve DiseasesHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMaleMiddle AgedMinnesotaPostoperative ComplicationsRetrospective StudiesRisk FactorsSeverity of Illness IndexTime FactorsTreatment Outcome