RESUMO
BACKGROUND: Results and durability of aortic valve replacement in aortic stenosis are well known, but no study has focused on the results of aortic valve replacement in aortic insufficiency. AIM: The aim of this retrospective study was to describe our mid-term outcomes after aortic valve replacement for aortic insufficiency. METHODS: All consecutive adult patients who underwent bioprosthetic aortic valve replacement for aortic insufficiency at two European centres (in France and Germany) between May 2005 and December 2020 were analysed. RESULTS: During the study period, 289 patients were included. Mean age was 56.9±12.5 years. Overall operative mortality was 1.5%, and the 10-year survival estimate rate was 75.0%, which was significantly lower than in the age- and sex-matched general population, with a standardized mortality ratio of 2.88 (95% confidence interval 1.96-4.08; P<0001). Freedom from aortic valve-related death was 87.6%, and from aortic valve-related reoperation was 87.4%. No patient aged>60 years was reoperated on during follow-up. Freedom from severe structural valve deterioration at 10 years was 73.3%, and freedom from moderate structural valve deterioration at 10 years was 50.3%. Freedom from major adverse valve-related events at 10 years was 69.7%. CONCLUSIONS: Although bioprosthetic aortic valve replacement for aortic insufficiency shows good early results, 10-year mortality and major adverse valve-related event rates in young patients may be a concern, with a reduction in life expectancy compared with the general population.
Assuntos
Insuficiência da Valva Aórtica , Estenose da Valva Aórtica , Bioprótese , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Adulto , Humanos , Pessoa de Meia-Idade , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estudos Retrospectivos , Complicações Pós-Operatórias , Próteses Valvulares Cardíacas/efeitos adversos , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/etiologia , Estenose da Valva Aórtica/cirurgia , ReoperaçãoAssuntos
Aneurisma da Aorta Torácica/diagnóstico por imagem , Dissecção Aórtica/diagnóstico por imagem , Hematoma/diagnóstico por imagem , Tomografia de Coerência Óptica/métodos , Doença Aguda , Adulto , Dissecção Aórtica/complicações , Dissecção Aórtica/cirurgia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/cirurgia , Procedimentos Cirúrgicos Cardíacos/métodos , Evolução Fatal , Feminino , Hematoma/cirurgia , Humanos , Complicações Pós-Operatórias/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Choque Cardiogênico/diagnóstico , Choque Cardiogênico/etiologiaRESUMO
We report a case of left main coronary artery thrombosis 7 days after aortic valve replacement for native aortic valve regurgitation. The patient had undergone apicoaortic conduit implantation 3 years earlier. The thrombosis resulted from deviation of the cardiac output through the apicoaortic conduit and consequent turbulence of flow in the ascending aorta. Despite thrombus aspiration from the left main coronary artery, the patient never recovered and died 2 days later from multiple organ failure.
