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October 24-25, 2019 | Tokyo, Japan

Jae Won Lee

Oral Presenter at Cardiology World Congress 2019- Jae Won Lee
Jae Won Lee
Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
Title : Clinical outcomes of Valve Sparing Root Replacement in Patients with Annuloaortic Ectasia

Abstract:

With excellent long-term outcomes of Aortic valve (AV)-sparing root replacement (VSRR) reported by expert groups, it has been regarded as a reasonable option to treat annuloaortic ectasia (AAE); however, data on VSSR outcomes from Korea have been limitedly reported. This study aims to report our long-term surgical outcomes of VSSR.

Methods:

We reviewed consecutive 168 patients (48.1±15.8 years; 47 women, 18 acute aortic dissection) who underwent VSSR between 1998 and 2018. Long-term clinical outcomes and AV durability were assessed by Kaplan-Meier estimates. Multivariable Cox-proportional hazard model was used to determine risk factors of postoperative significant AI (moderate-to-severe).

Results:

During the study period, the use of VSRR among entire root replacement to treat AAE (n=158) has increased significantly over time (22.9% in 1st period-quartile to 39.4% in 4th quartile, p<0.001). Rate of Bentall-conversion was 6.0% (n=10). No early mortality occurred in the 168 VSRR patients. 5-year survival and free from reoperation were 96.0±2.1% and 90.3±3.7%, respectively, while there were no cases of endocarditis, thromboembolism or haemorrhagic events during follow-up. 5-year freedom from severe AI was 81.1±5.1%. On multivariable analyses, higher grade of preoperative AI (HR, 1.46; 95% CI 1.16-4.28; p=0.05) and low-volume surgeon (HR, 2.23; 95% CI 1.16-4.28; p=0.02) were significantly associated with the postoperative significant AI.

Conclusion:

VSSR for aortic root dilatation has been increasingly performed, and the clinical results seem to be acceptable. Preoperative level of AI and surgeon factors were associated with the risk of postoperative AI.

Audience take away: 

  • David operation is an established and approved surgical procedure for the treatment of annuloaortic ectasia associated with or without aortic insufficiency
  • As the surgical outcomes can be highly variable according to the operating surgeon’s experience, continuous efforts are required to pass the learning curve of this type procedure
  • In our analysis, accumulation of 20 cases of this procedure was turned out to be the cut-off value predictive for surgical success. A team approach would be more reasonable for young and less-experienced surgeons

Biography:

There are many clinical and echocardiographic parameters factors which predict recurrence of atrial fibrillation (AF) after cardioversion (CV) to sinus rhythm (SR) as well as long-term maintenance of SR. 
This study determined the clinical, transthoracic echocardiographic and transesophageal echocardiographic (TEE)  parameters that predict maintenance of SR in 223 patients with nonvalvular AF after CV. Before CV TEE performed in all patients. Thirteen
patients had spontaneously CV prior to TEE.  Seven patients were excluded because of left atrial (LA) thrombus assessed by TEE. CV was unsuccessful in 21 patients. The remaining 182 consecutive patients (106 men, 76 women, mean age 61 +/- 5.4 years), who had been successfully cardioverted to SR, were prospectively included in the study.  One hundred fourteen(63%) patients were still in SR 6 months after CV. After one year fifty four (48%) patinets  were still in SR.
Duration of AF, LA diameter, left atrial volume index (LAVI) , older age, hypertension, coronary artery disease,  left ventricular ejection fraction (EF), alcohol consumption, use of  antiarrhythmic drugs predicted recurrence of AF 6 months after CV.  
Gender, diabetes,  chronic obstructive pulmonary disease, mitral annulus calcification, and mitral valve prolapse (MVP) did not predict recurrence. 
Dr. Lee studied and graduated at the Seoul National University college of Medicine, Seoul, South Korea. He was trained at the Seoul National University Hospital and received his PhD degree at the same institution. He also received clinical fellowship training at the Toronto General Hospital supervised by Dr. Tirone E. David. He has published more than 180 research articles in SCI(E) journals.