Published Online
on December 5, 2005

A more recent version of this article appeared on December 13, 2005

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Submitted on January 12, 2005
Revised on September 12, 2005
Accepted on September 14, 2005

Surgical Treatment of Aortic Regurgitation due to Takayasu Arteritis. Long-Term Morbidity and Mortality

Kaoru Matsuura MD, Hitoshi Ogino MD^*, Junjiro Kobayashi MD, Hatsue Ishibashi-Ueda MD, Hitoshi Matsuda MD, Kenji Minatoya MD, Hiroaki Sasaki MD, Ko Bando MD, Kazuo Niwaya MD, Osamu Tagusari MD, Hiroyuki Nakajima MD, Toshikatsu Yagihara MD, and Soichiro Kitamura MD

From the Departments of Cardiovascular Surgery (K. Matsuura, H.O., J.K., H.M., K. Minatoya, H.S., K.B., K.N., O.T., H.N., T.Y., S.K.) and Pathology (H.I.-U.), National Cardiovascular Center, Osaka, Japan.

^* To whom correspondence should be addressed. E-mail: hogino{at}hsp.ncvc.go.jp.

Background--The goal of this retrospective study was to determine the late outcome of surgical treatment for aortic valve regurgitation due to Takayasu arteritis and correlate it with evidence of inflammation on pathological examination.

Methods and Results--Ninety consecutive patients who underwent surgery for aortic valve regurgitation due to Takayasu arteritis between 1979 and 2003 were studied. Intraoperative pathological specimens of the aortic wall from 69 patients were retrospectively examined for inflammation. Aortic valve replacement was performed in 63 patients (group A) and composite graft repair in 27 patients (group B). The aortic root diameter was 39.9±9.5 mm in group A and 54.4±13.6 mm in group B (P<0.0001). Preoperative steroid therapy was performed in 40 patients (44.4%). Hospital mortality was 4.8% (3/63) in group A and 7.4% (2/27) in group B. The overall 15-year survival rate was 76.1%. Detachment of the valve or graft occurred in 11.1% (7/63) of group A and in 3.7% (1/27) of group B patients (P=0.43). Late dilatation (>50 mm) of the residual ascending aorta occurred in 11.1% (7/63) of group A and in 3.7% (1/27) of group B patients (P=0.43). Active inflammation was confirmed in intraoperative pathological specimens of 10 patients, and detachment of the valve or graft occurred in 4 of these patients. Univariate analysis of background variables revealed active inflammation to be a risk factor for detachment (P=0.0001; risk ratio 55).

Conclusions--Late dilatation of the ascending aorta after aortic valve replacement is a clinically important finding. Active inflammation could be related to valve or graft detachment.

Key words: aorta • complications • inflammation • surgery • valves

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