RESUMEN
BACKGROUND AND AIM OF THE STUDY: Bicuspid aortic valve (BAV), though normally functioning, is frequently associated with dilatation of the aortic root and ascending aorta. Optimal surgical treatment remains controversial. The study aim was to evaluate the fate of the normally functioning spared BAV at long-term follow up. METHODS: Forty patients (26 males, 14 females; mean age 59 +/- 11 years; range: 38-81 years) who underwent aortic surgery for proximal aortic disease between 1996 and 2011, with spared BAV at surgery, were included in the study. The main indication for surgery was ascending aorta aneurysm. Of the patients, 37 had ascending aorta replacement and three underwent a semi-Yacoub procedure. Adjunctive subcommissural annuloplasty was performed in 12 cases. The clinical and echocardiographic follow up (median 62 months; range: 7-175 months) was 100% complete. RESULTS: In-hospital survival was 100%. Pre-discharge echocardiography showed no cases of significant aortic regurgitation (grade > or = 3+) or stenosis. The probability of survival at five and 10 years was 93 +/- 7% and 79 +/- 10%, respectively. Two surviving patients (5%) required reoperation for the development of aortic insufficiency. Freedom from aortic valve replacement was 100% and 90 +/- 10% at five and 10 years, respectively, and freedom from thromboembolic or bleeding events was 100% and 90 +/- 10% at five and 10 years, respectively. No cases of endocarditis were reported. The composite event-free survival at five and eight years was 85 +/- 6% and 69 +/- 11%, respectively. There were no cases of root enlargement during the follow up period. CONCLUSION: A spared BAV offers a good time-span of functional integrity. The conservative approach seems to be a valid strategy, with a low risk of reintervention and cardiovascular events during long term follow up, in selected patients.
Asunto(s)
Aorta/cirugía , Aneurisma de la Aorta/cirugía , Válvula Aórtica/anomalías , Implantación de Prótesis Vascular , Enfermedades de las Válvulas Cardíacas/fisiopatología , Adulto , Anciano , Anciano de 80 o más Años , Aorta/fisiopatología , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/etiología , Aneurisma de la Aorta/mortalidad , Aneurisma de la Aorta/fisiopatología , Válvula Aórtica/fisiopatología , Válvula Aórtica/cirugía , Enfermedad de la Válvula Aórtica Bicúspide , Implantación de Prótesis Vascular/efectos adversos , Implantación de Prótesis Vascular/mortalidad , Anuloplastia de la Válvula Cardíaca , Supervivencia sin Enfermedad , Femenino , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/diagnóstico , Enfermedades de las Válvulas Cardíacas/mortalidad , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/cirugía , Modelos de Riesgos Proporcionales , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: The diagnosis and surgical treatment of patients with Marfan syndrome remain controversial. It is of utmost importance to identify patients at risk for acute aortic events to establish the correct surgical timing and the appropriate surgical treatment. METHODS: From May 2008 to December 2012, 500 patients were screened at the Marfan Presidium of the Tor Vergata University Hospital of Rome (Italy). Patients were evaluated by a cardiac surgeon, including echocardiographic, orthopedic, ophthalmologic and dental examinations. All patients received genetic counseling, and genetic sampling was performed if appropriate. RESULTS: The diagnosis of Marfan syndrome was confirmed in 146 patients (29.2%). Fifty-four patients (37%) underwent cardiac surgery on the aortic root, 4 patients had surgery on the mitral valve, 13 patients had combined surgery; 11 cases were emergent surgery for acute aortic dissection. Twenty-eight patients (52%) were operated on at our Division: 13 underwent valve-sparing aortic root replacement (David procedure), 1 underwent Yacoub remodeling procedure and 14 underwent Bentall procedure. Following the establishment of the Marfan Center, the David aortic valve-sparing operation was the most frequently performed procedure compared to the previous period of surgical activity (63 vs 22%, p<0.0001). CONCLUSIONS: Regular follow-up twice a year may allow to identify patients at risk for acute aortic syndromes. Early surgical treatment is recommended in these patients to achieve optimal results of valve-sparing procedures and life-saving management, especially for patients who live far away from a cardiac surgery center.