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Brazilian Single-Center Experience with Aortic Root Replacement in 448 Patients: What Is the Best Technique?
INTRODUCTION: The objective of this study was to evaluate whether a surgery with the use of valved conduit is capable of leading to better immediate and late results than those obtained by the valve-sparing aortic root reconstruction technique. METHODS: Between January 2002 and June 2016, 448 patien...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Sociedade Brasileira de Cirurgia Cardiovascular
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731868/ https://www.ncbi.nlm.nih.gov/pubmed/33113317 http://dx.doi.org/10.21470/1678-9741-2020-0043 |
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author | Dinato, Fabrício José Dias, Ricardo Ribeiro Duncan, José Augusto Fernandes, Fábio Ramirez, Felix José Alvares Mady, Charles Jatene, Fabio B |
author_facet | Dinato, Fabrício José Dias, Ricardo Ribeiro Duncan, José Augusto Fernandes, Fábio Ramirez, Felix José Alvares Mady, Charles Jatene, Fabio B |
author_sort | Dinato, Fabrício José |
collection | PubMed |
description | INTRODUCTION: The objective of this study was to evaluate whether a surgery with the use of valved conduit is capable of leading to better immediate and late results than those obtained by the valve-sparing aortic root reconstruction technique. METHODS: Between January 2002 and June 2016, 448 patients underwent aortic root reconstruction. These were divided into three groups according to the technique used: 319 (71.2%) patients received mechanical valved conduits, 49 (10.9%) received biological valved conduits, and 80 (17.9%) underwent the valve-sparing aortic root reconstruction technique. The results were examined by univariate and multivariate analyses of Cox proportional hazards models with multiple logistic regression. RESULTS: The hospital mortality rate was 7.5%. The mortality rates were 8.2%, 12%, and 2.5% in the mechanical valved conduit, biological valved conduit, and aortic valve-sparing groups, respectively, with no significant difference between groups (P=0.1). Thromboembolic complications and reoperation-free survival were also similar (P=0.169 and P=0.688). However, valve-sparing aortic root replacement was superior in terms of long-term survival (P<0.001), hemorrhagic-free survival (P<0.001), and endocarditis-free survival (P=0.048). Multivariate analysis showed that the following aspects had an impact on mortality: age > 70 years (P<0.001; hazard ratio [HR] 1.05), preoperative acute kidney injury (P<0.0042; HR 2.9), diagnosis of dissection (P<0.01; HR 2.0), previous cardiac surgery (P<0.027; HR 2.3), associated coronary artery bypass grafting (P<0.038; HR 1.8), reoperation for postoperative tamponade (P<0.004; HR 2.2) and postoperative acute kidney injury (P<0.02; HR 3.35). CONCLUSION: Valve-sparing technique seems to be the operation of choice, whenever possible, for aortic root reconstruction. |
format | Online Article Text |
id | pubmed-7731868 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Sociedade Brasileira de Cirurgia Cardiovascular |
record_format | MEDLINE/PubMed |
spelling | pubmed-77318682020-12-16 Brazilian Single-Center Experience with Aortic Root Replacement in 448 Patients: What Is the Best Technique? Dinato, Fabrício José Dias, Ricardo Ribeiro Duncan, José Augusto Fernandes, Fábio Ramirez, Felix José Alvares Mady, Charles Jatene, Fabio B Braz J Cardiovasc Surg Original Article INTRODUCTION: The objective of this study was to evaluate whether a surgery with the use of valved conduit is capable of leading to better immediate and late results than those obtained by the valve-sparing aortic root reconstruction technique. METHODS: Between January 2002 and June 2016, 448 patients underwent aortic root reconstruction. These were divided into three groups according to the technique used: 319 (71.2%) patients received mechanical valved conduits, 49 (10.9%) received biological valved conduits, and 80 (17.9%) underwent the valve-sparing aortic root reconstruction technique. The results were examined by univariate and multivariate analyses of Cox proportional hazards models with multiple logistic regression. RESULTS: The hospital mortality rate was 7.5%. The mortality rates were 8.2%, 12%, and 2.5% in the mechanical valved conduit, biological valved conduit, and aortic valve-sparing groups, respectively, with no significant difference between groups (P=0.1). Thromboembolic complications and reoperation-free survival were also similar (P=0.169 and P=0.688). However, valve-sparing aortic root replacement was superior in terms of long-term survival (P<0.001), hemorrhagic-free survival (P<0.001), and endocarditis-free survival (P=0.048). Multivariate analysis showed that the following aspects had an impact on mortality: age > 70 years (P<0.001; hazard ratio [HR] 1.05), preoperative acute kidney injury (P<0.0042; HR 2.9), diagnosis of dissection (P<0.01; HR 2.0), previous cardiac surgery (P<0.027; HR 2.3), associated coronary artery bypass grafting (P<0.038; HR 1.8), reoperation for postoperative tamponade (P<0.004; HR 2.2) and postoperative acute kidney injury (P<0.02; HR 3.35). CONCLUSION: Valve-sparing technique seems to be the operation of choice, whenever possible, for aortic root reconstruction. Sociedade Brasileira de Cirurgia Cardiovascular 2020 /pmc/articles/PMC7731868/ /pubmed/33113317 http://dx.doi.org/10.21470/1678-9741-2020-0043 Text en http://creativecommons.org/licenses/by/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Dinato, Fabrício José Dias, Ricardo Ribeiro Duncan, José Augusto Fernandes, Fábio Ramirez, Felix José Alvares Mady, Charles Jatene, Fabio B Brazilian Single-Center Experience with Aortic Root Replacement in 448 Patients: What Is the Best Technique? |
title | Brazilian Single-Center Experience with Aortic Root Replacement in 448 Patients: What Is the Best Technique? |
title_full | Brazilian Single-Center Experience with Aortic Root Replacement in 448 Patients: What Is the Best Technique? |
title_fullStr | Brazilian Single-Center Experience with Aortic Root Replacement in 448 Patients: What Is the Best Technique? |
title_full_unstemmed | Brazilian Single-Center Experience with Aortic Root Replacement in 448 Patients: What Is the Best Technique? |
title_short | Brazilian Single-Center Experience with Aortic Root Replacement in 448 Patients: What Is the Best Technique? |
title_sort | brazilian single-center experience with aortic root replacement in 448 patients: what is the best technique? |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731868/ https://www.ncbi.nlm.nih.gov/pubmed/33113317 http://dx.doi.org/10.21470/1678-9741-2020-0043 |
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